Presumed β-Lactam Allergy and Cross-reactivity in the Operating Theater: A Practical Approach

A β-LACTAM allergy is the most common suspected inhospital 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.1-5 Thus, the team in the operating theater will be confronted with these patients when perioperative antibiotic prophylaxis is needed. 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 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.4 In fact, the overuse of non-β-lactam antibiotics because of reported penicillin allergy has been labeled a public health problem.6-8 In this review, we provide an evidencebased 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.