![]() ![]() Histories were taken by a trained nurse or pharmacy assistant for all included patients. In a recent Dutch study in a university hospital, the prevalence of penicillin allergy was 5.6%. In addition, after evaluation of the symptoms alone, in 11.7% allergy to lactams could be ruled out. Less than 50% of patients with a documented warning against β-lactams had a description of the symptoms included in their general practitioner file. Patient records often also lack information on allergy, as Salden et al. However, most patients did remember the type of reaction, which was cutaneous rash in the vast majority. Only 43% remembered why they were treated with penicillin at that time. 14 illustrated in 96 patients with a history of penicillin allergy that 82% did not remember which kind of penicillin they were allergic to and the mean time between the allergic reaction and the study interview was 20 yr. 3 The reported β-lactam allergy by the patient is often not clarified in medical documentation, and taking a history can prove to be difficult. The most frequently reported β-lactam allergy is penicillin allergy, which comprises more than 50% of all antibiotic allergies reported before surgery. The main β-lactam groups are the penicillins, cephalosporins, carbapenems, and monobactams. 6–8 In this review, we provide an evidence-based and practical approach to patients with presumed β-lactam allergy admitted to the operating theater and give guidance on the selection of alternative antibiotics based on cross-reactivity patterns. 4 In fact, the overuse of non–β-lactam antibiotics because of reported penicillin allergy has been labeled a public health problem. 1 This may be a short-term risk-avoiding strategy during surgery, but the long-term consequences are overuse of these agents and an increase in serious hospital infections by pathogens such as Clostridium difficile and vancomycin-resistant Enterococcus, with an accompanied rise in healthcare use and costs. Frequently, the consequence of a presumed β-lactam allergy is that all β-lactam antibiotics are avoided, because of the possibility of cross-reactivity, and an alternative antibiotic, e.g., clindamycin, vancomycin, or ciprofloxacin, is prescribed. 1–5 Thus, the team in the operating theater will be confronted with these patients when perioperative antibiotic prophylaxis is needed. A β-lactam allergy is the most common suspected in-hospital drug allergy, with an incidence of 5 to 17% in hospitalized patients and up to 35% in the surgical population at the preoperative assessment clinic. ![]()
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