Additionally, first generation cephalosporins can be used as alternative therapy for uncomplicated cystitis and alternative prophylaxis against infective endocarditis. This generation is used as first line therapy for Group A streptococcus (GAS) pharyngitis, outpatient treatment for mild diabetic foot infections (DFIs), mild-to-moderate intra-abdominal infections (IAIs), cholecystitis, combat wounds, and prosthetic joint infections (PJIs). Cefazolin is also used as prophylaxis with the insertion of a cardiac device and as prophylaxis for endometritis. First generation cephalosporins are commonly prescribed for surgical site infection (SSI) prophylaxis for almost all surgeries, either as monotherapy or as combination therapy. The purpose of this review is to provide an overview of the role of cephalosporins in clinical practice, and to highlight the incidence of, risk factors for, and cross-reactivity of cephalosporins with other antibiotics.įirst generation cephalosporins include cefazolin and cephalexin, and these agents are known for their coverage of methicillin-sensitive Staphylococcus aureus (MSSA) and streptococci with some Gram-negative bacilli coverage. Clinicians should consider the low likelihood of true cephalosporin allergy when clinically indicated. Cephalosporin cross-reactivity potential is related to the structural R1 side chain, and clinicians should be cognizant of R1 side chain similarities when prescribing alternate β-lactams in allergic individuals or when new cephalosporins are brought to market. Risk factors for cephalosporin allergies are broad and include female sex, advanced age, and a history of another antibiotic or penicillin allergy however, cephalosporins are readily tolerated even among individuals with true immediate-type allergies to penicillins. The misdiagnosis of β-lactam allergies and misunderstanding of cross-reactivity among β-lactams, including within the cephalosporin class, often leads to use of broader spectrum antibiotics with poor safety and efficacy profiles and represents a serious obstacle for antimicrobial stewardship. However, clinicians may avoid the use of cephalosporins in patients with reported penicillin allergies despite the low potential for cross-reactivity. Cephalosporins are among the most commonly prescribed antibiotic classes due to their wide clinical utility and general tolerability, with approximately 1–3% of the population reporting a cephalosporin allergy.
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