Penicillin Allergy Pathway for Antibiotic Prescription in Patients With Penicillin Allergy

Mild Reaction - Itching, Minor rash (not hives), Maculopapular rash (mild type IV HSR), EMR lists allergy, but patient denies

 • Use full-dose third-/fourth-generation cephalosporin OR

 • Use penicillin or first-/second- generation cephalosporin by Test Dose Procedure OR

 • Use carbapenem

Type I (lgE-Mediated) HSR - Anaphylaxis, Angioedema, Wheezing, Laryngeal edema, Hypotension, Hives/urticaria OR

Unknown reaction WITHOUT mucosal involvement, skin desquamation, or organ involvement

 • Use third-/fourth-generation cephalosporins or carbapenems by Test Dose Procedure OR

 • Use alternative agent by microbial coverage OR

 • Aztreonam

 • If infectious disease consult determines that penicillin or a first-/second- generation cephalosporin is the preferred therapy, or that one of the alternative agents is substandard, consult Allergy

Type II-IV HSR - Serum sickness, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Acute interstitial nephritis, Drug rash eosinophilia systemic symptoms syndrome, Hemolytic anemia

 • Avoid using penicillin or cephalosporin; use alternative agents by microbial coverage

 • If there is a strong clinical indication for use of penicillin or cephalosporin, please involve the Allergy and Infectious Disease services



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