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JAC Advance Access originally published online on May 16, 2007
Journal of Antimicrobial Chemotherapy 2007 60(1):107-111; doi:10.1093/jac/dkm146
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Aminopenicillin-induced exanthema allows treatment with certain cephalosporins or phenoxymethyl penicillin

Jiri Trcka1,2, Cornelia S. Seitz1, Eva-B. Bröcker1, Gerd E. Gross2 and Axel Trautmann1,*

1 Department of Dermatology, Venerology and Allergology, University of Würzburg, Würzburg, Germany 2 Department of Dermatology and Venerology, University of Rostock, Rostock, Germany

Received 3 December 2006; returned 26 February 2007; revised 20 March 2007; accepted 18 April 2007

* Corresponding author. Tel: +49-931-201-26710; Fax: +49-931-201-26700; E-mail: trautmann_a{at}klinik.uni-wuerzburg.de

Objectives: Aminopenicillin-induced exanthema poses a problem in the management of infectious diseases. Due to theoretically possible immunological cross-reactivity, all ß-lactam drugs, i.e. penicillins, penicillin derivatives and cephalosporins, are usually avoided. The available alternative antibiotics (macrolides, quinolones and glycopeptides) may be less effective, have more side effects, and their use increases medical costs. Moreover, their use contributes to the increasing bacterial resistance to antibiotics. The aim of the study is to demonstrate that patients with aminopenicillin-induced exanthema may receive specific ß-lactams for future antibiotic therapy.

Methods: Skin testing followed by oral challenges to identify ß-lactams that are tolerated by patients despite confirmed delayed-type non-immunoglobulin E (IgE)-mediated allergic hypersensitivity to aminopenicillins.

Results: Sixty-nine out of 71 patients (97.2%) with non-IgE-mediated allergic hypersensitivity to aminopenicillins tolerate cephalosporins without an aminobenzyl side chain such as cefpodoxime or cefixime and 51 patients (71.8%) also tolerate phenoxymethyl penicillin.

Conclusions: The majority of patients with non-IgE-mediated allergic hypersensitivity to aminopenicillins do not cross-react to certain cephalosporins or phenoxymethyl penicillin. Skin and drug challenge tests can be helpful to determine individual cross-reactivity.

Keywords: drug challenge , drug provocation , non-IgE-mediated allergic hypersensitivity , skin tests


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