Antibiotic Recommendations with Penicillin or Cephalosporin Allergy
| Determine risk stratification based on Penicillin ADR (HISTORICAL) Clinical Pathway | ||
Allergy |
Treatment Recommendations |
Notes |
| Penicillin: Low risk OR High risk for IgE-mediated reaction (including prior anaphylaxis) |
Cefpodoxime 5 mg/kg/dose PO BID (max 200 mg/dose) |
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| Cefuroxime 250 mg PO BID for children able to swallow pills |
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| Cefixime 4 mg/kg/dose PO BID (max 200 mg/dose) PLUS Clindamycin 10 mg/kg/dose PO TID (max dose 600 mg/dose) |
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| Penicillin: High risk for severe delayed reaction (severe cutaneous reactions (e.g., SJS, DRESS) |
Levofloxacin 10 mg/kg/dose PO BID (6 mo - 5 years) OR qday (> 5 years) (max 500 mg/day) |
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| Cephalosporin: Low risk for IgE-mediated reaction |
Amoxicillin 45 mg/kg/dose PO BID (max 2000 mg/dose) |
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| Amoxicillin-clavulanate 45 mg/kg/dose (amoxicillin component) PO BID (max 2000 mg/dose) | ||
| Cephalosporin: High risk for IgE-mediated or severe delayed reaction (e.g., SJS, DRESS) |
Levofloxacin 10 mg/kg/dose PO BID (6 mo - 5 years) OR qday (> 5 years) (max 500 mg/day) |
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| Recommend referral for beta lactam allergy testing and potential de-labeling. At Children's Mercy, Infectious Diseases Clinic provides penicillin testing and Allergy Immunology Clinic provides testing for ALL beta lactams. |
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Chow, A. W., Benninger, M. S., Brook, I., Brozek, J. L., Goldstein, E. J. C., Hicks, L. A., Pankey, G. A., Seleznick, M., Volturo, G., Wald, E. R., & File, T. M. (2012). Executive Summary: IDSA Clinical Practice Guideline for Acute Bacterial Khan, D. A., Banerji, A., Blumenthal, K. G., Phillips, E. J., Solensky, R., White, A. A., Bernstein, J. A., Chu, D. K., Ellis, A. K., Golden, D. B. K., Greenhawt, M. J., Horner, C. C., Ledford, D., Lieberman, J. A., Oppenheimer, J., Rank, M. A., Shaker, M. S., Stukus, D. R., Wallace, D., Wang, J.,... Wang, J. (2022). Drug allergy: A 2022 practice parameter update. The Journal of allergy and clinical immunology, 150(6), 1333-1393. https://doi.org/10.1016/j.jaci.2022.08.028 Wald, E. R., Applegate, K. E., Bordley, C., Darrow, D. H., Glode, M. P., Marcy, S. M., Nelson, C. E., Rosenfeld, R. M., Shaikh, N., Smith, M. J., Williams, P. V., & Weinberg, S. T. (2013). Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. PEDIATRICS, 132(1), e262-e280. https://doi.org/10.1542/peds.2013-107 |
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These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.