Safety of cefuroxime as an alternative in patients with a proven hypersensitivity to penicillins: a DAHD cohort survey.

OBJECTIVE

In patients sensitized to beta-lactams, a safe beta-lactam alternative is often needed. The objective was to assess the safety of cefuroxime in patients with a proven beta-lactam allergy.

DESIGN

Using the Drug Allergy and Hypersensitivity Database cohort, patients with a proven beta-lactam allergy and tested for cefuroxime between September 1996 and April 2007 were selected. The European Network of Drug Allergy recommendations were followed. Prevalence of sensitization to cefuroxime (as an alternative) was established in patients with a proven beta-lactam allergy.

RESULTS

Amongst the 650 subjects tested, 143 (22.0%) presented at least one beta-lactam sensitization other than cefuroxime [39-27.3% male, median age at test 44.0 (32.0-56.0) years]. One hundred and eighteen (82.5%) were sensitized to penicillins, 8 (5.6%) to cephalosporins and 17 (11.9%) to both penicillins and cephalosporins. Nine (6.3%) patients were sensitized to cefuroxime (6 diagnosed by provocation test): 5 (55.6%) in the penicillin-only allergic group and 4 (44.4%) in the penicillin and cephalosporin allergic group. Prevalence of cefuroxime hypersensitivity reaction in patients sensitized to beta-lactams was 6.3% (95% CI 2.3-10.3%) and in those sensitized to penicillin 4.2% (95% CI 0.6-7.9). This rate decreased to 2.9% (95% CI 0-6.9) in patients with prior histories involving a penicillin only (without any history involving an unknown beta-lactam).

CONCLUSION

Cefuroxime appeared to be a safe alternative in beta-lactam-allergic patients after testing. The risk of giving cefuroxime being not null, a thorough drug allergy work-up, including provocation test, is still needed.