Recommendations for the Management of BetaLactam

Authors: Eric Macy Eunis Ngor

Publish Date: 2013/04/04

Volume: 47, Issue: 1, Pages: 46-55

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Abstract

Avoid testing rechallenging or desensitizing individuals with histories of betalactam associated toxic epidermal necrolysis Stevens–Johnson syndrome drug reaction with eosinophilia and systemic symptoms syndrome severe hepatitis interstitial nephritis or hemolytic anemiaFor individuals with an appropriate penicillin class antibiotic intolerance based on a history of anaphylaxis urticaria macular papular rashes unknown symptoms or symptoms not excluded in step one proceed with penicillin skin testing Skin test with penicilloylpolylysine and native penicillin If skin test is negative proceed with an oral amoxicillin challenge If skin test and oral challenge are negative penicillin class antibiotics may be used If skin test or oral challenge is positive avoid penicillin class antibiotics If skin test or oral challenge is positive nonpenicillinbetalactams may be used unless there is a history of intolerance to a specific nonpenicillinbetalactam then avoid that specific nonpenicillinbetalactam If there is lifethreatening infection that can only be treated with a penicillin class antibiotic proceed with oral penicillin desensitization prior to any oral or parenteral penicillin useFor individuals with an appropriate nonpenicillinbetalactam intolerance avoid reexposure to the betalactam implicated An alternative betalactam may be used ideally with different side chains Penicillin allergy testing is not useful in the management of nonpenicillinbetalactam intolerance Nonpenicillinbetalactam skin testing is not clinically useful and should not be done outside of a research setting If the nonpenicillinbetalactam implicated is needed to treat a lifethreatening infection proceed with desensitization

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