• Richard H Epstein, Paul St Jacques, Jonathan P Wanderer, Mark R Bombulie, and Niraj Agarwalla.
• From the *Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; †Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and ‡Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
• A A Case Rep. 2016 May 1; 6 (9): 263-7.

AbstractWe studied prophylactic antibiotics administered at 2 academic medical centers during a 6-year period where a cephalosporin was indicated but an "allergy" to penicillin was noted. Another drug (typically vancomycin or clindamycin) was substituted approximately 80% of the time; this occurred frequently even when symptoms unrelated to acute hypersensitivity were listed. In >50% of cases, the reaction was either omitted or vague (e.g., simply "rash"). Given the estimated 1% cross-reactivity between penicillins and cephalosporins with similar R1 side chains, many of these patients could have received either the prescribed cephalosporin or another cephalosporin with a different R1 side chain.

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