Guidance on Penicillin Allergy

A significant proportion of patients are incorrectly labeled “penicillin allergic” either on the basis of symptoms reflecting drug side-effects (e.g. nausea, diarrhoea) as opposed to allergy or on the basis of an inadequate history. To do so may deny the patient potentially life-saving treatment. A thorough, reliable history (from patient or family/ General Practitioner) is paramount to identify those with true allergy, be it mild or severe (anaphylaxis). Every effort should be made to document the exact nature of the patient’s drug allergy to penicillins/ beta-lactams MUST on the allergy section of the drug card and in the patients notes.

Characteristics Type I immediate Non-Type I reactions hypersensitivity reactions (Types II-IV and idiosyncratic) (ANAPHYLACTOID) Timing of onset 1 to 4 hours from exposure >72 hours from exposure (can occur up to 72 hours) Clinical signs Anaphylaxis Maculopapular rash Laryngeal oedema Morbilliform rash Wheezing / bronchospasm  red blood cells /  platelets Angioedema Drug fever (serum sickness) Urticaria / pruritis Tissue injury (immune complex) Diffuse erythema Contact dermatitis Classification SEVERE, life-threatening NON-SEVERE penicillin allergy Penicillin (and Beta-lactam allergy)

Avoid all drugs in RED and Avoid all drugs in RED YELLOW below Drugs in YELLOW can be used with caution- a proportion of patients will cross-react.

Red- Penicillins Yellow- other Beta-Lactams Amoxicillin Cefaclor Augmentin (co-amoxiclav) Cefalexin Benzathine penicillin Cefixime Benzylpenicillin (Penicillin G) Cefotaxime Flucloxacillin Ceftazidime Penicillin V (phenoxymethylpenicillin) Ceftriaxone Piperacillin Cefuroxime Procaine penicillin Ertapenem Tazocin (piperacillin / tazobactam) Imipenem (Primaxin) Timentin (ticarcillin / clavulanic acid) Meropenem Doripenem Aztreonam

See Below for the RBCH Penicillin Allergy Traffic Light Card

RBCH Foundation Trust. Guidance on Penicillin Allergy. RBCH AMT August 2011 (v2011.0) Page 1 of 2

The Royal Bournemouth and PHARMACY DEPARTMENT Christchurch Hospitals NHS (With acknowledgements to Foundation Trust King’s College Hospital Pharmacy Department)

PENICILLIN ALLERGY – Antibiotic prescribing in a penicillin allergic patient

Amoxicillin

Ampicillin ® Augmentin (co-amoxiclav) Flucloxacillin CONTRA- Penicillin G (benzylpenicillin) Penicillin V (phenoxymethyl- INDICATED (see notes below) penicillin) ® Tazocin (piperacillin plus tazobactam) ® Timentin (ticarcillin)

Cefaclor Cefotaxime Cefradine/ Cefalexin

Cefixime Ceftazidime Ceftriaxone Cefuroxime CAUTION Primaxin® (Imipenem plus (see notes below) cilastin)

Meropenem Doripenem Ertapenem Aztreonam

Amikacin Minocycline Azithromycin Moxifloxacin Chloramphenicol Nitrofurantoin Ciprofloxacin Norfloxacin Clarithromycin Oxytetracycline Clindamycin Rifampicin CONSIDERED Colistin Sodium Fusidate Co-trimoxazole Synercid SAFE Daptomycin Teicoplanin Doxycycline Tetracycline Erythromycin Tigecycline Gentamicin Trimethoprim Linezolid Tobramycin Metronidazole Vancomycin

NOTES: Please seek expert microbiology advice in cases of severe infection. Individuals with a documented history of anaphylaxis, immediately after penicillin administration are at risk of immediate hypersensitivity to a penicillin: these individuals should not receive a penicillin, a cephalosporin or other beta-lactam antibiotic. Please discuss alternative therapy with a medical microbiologist. RBCH Foundation Trust. Guidance on Penicillin Allergy. RBCH AMT August 2011 (v2011.0) Page 2 of 2