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The contraindication, however, should be viewed in the light of recent epidemiological work suggesting, for many second-generation (or later) cephalosporins, the cross-reactivity rate with penicillin is much lower, having no significantly increased risk of reactivity over the first generation based on the studies examined.
Nevertheless, the risk of cross-reactivity is sufficient to warrant the contraindication of all β-lactam antibiotics in patients with a history of severe allergic reactions (urticaria, anaphylaxis, interstitial nephritis) to any β-lactam antibiotic. Rarely, allergic reactions have been triggered by exposure from kissing and sexual contact ...
Side effects associated with use of cefazolin therapy include: [8] Common (1–10%): diarrhea, stomach pain or upset stomach, vomiting, and rash. Uncommon (<1%): dizziness, headache, fatigue, itching, transient hepatitis. [13] Patients with penicillin allergies could experience a potential reaction to cefazolin and other cephalosporins. [8]
PBPs normally catalyze the cross-linking of the bacterial cell wall, but they can be permanently inhibited by penicillin and other β-lactam antibiotics. (NAM = N-acetylmuramic acid; NAG = N-acetylglucosamine) [2] Penicillin-binding proteins (PBPs) are a group of proteins that are characterized by their affinity for and binding of penicillin.
Additionally, those with penicillin allergies can usually tolerate cephalosporins (another group of β-lactam) because the immunoglobulin E (IgE) cross-reactivity is only 3%. [5] Penicillin was discovered in 1928 by Scottish scientist Alexander Fleming as a crude extract of P. rubens. [6]
If someone has developed side effects when taking penicillin, these side effects may develop with a new medication even though the person has not taken the new medication before. Those medications that may cause a cross sensitivity reaction are: carbapenems, ampicillin, cefazolin, cephalosporins and cloxacillin. [9] [8] [10]
The β-lactam core structures. (A) A penam.(B) A carbapenam.(C) An oxapenam.(D) A penem.(E) A carbapenem.(F) A monobactam.(G) A cephem.(H) A carbacephem.(I) An oxacephem. This is a list of common β-lactam antibiotics—both administered drugs and those not in clinical use—organized by structural class.
Monobactam antibiotics exhibit no IgE cross-reactivity reactions with penicillin but have shown some cross reactivity with cephalosporins, most notably ceftazidime, which contains an identical side chain as aztreonam. [9] Monobactams can trigger seizures in patients with history of seizures, although the risk is lower than with penicillins.