Common antibiotic can safely be given to most surgery patien
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Most surgical patients with a history of penicillin allergy can safely be given the guideline-recommended antibiotic cefazolin to prevent infection instead of several penicillin alternatives that are less effective and more expensive, according to a study. The researchers reported in JAMA Surgery that the frequency of allergies to both penicillins and cefazolin was so small that most patients should receive cefazolin regardless of their allergy history.

The aim of this study was to examine the incidence of dual allergy to cefazolin and natural penicillins.

In this systematic review and meta-analysis, a search of MEDLINE/PubMed, Web of Science, and Embase were performed, for studies that included patients who had index allergies to natural penicillin and were tested for tolerability to cefazolin or that included patients who had index allergies to cefazolin and were tested for tolerability to natural penicillin. A total of 3228 studies were identified and 2911 were screened for inclusion.

77 unique studies met the eligibility criteria, yielding 6147 patients.

--Cefazolin allergy was identified in 44 participants with a history of penicillin allergy, resulting in a dual allergy meta-analytical frequency of 0.7%.

--Such frequency was lower for participants with unconfirmed than for those with confirmed penicillin allergy.

--Thirteen studies exclusively assessed surgical patients, among whom 0.7% had confirmed allergy to cefazolin.

--Low heterogeneity was observed for studies of patients with unconfirmed penicillin allergy who had been exposed to perioperative cefazolin.

--Penicillin allergy was confirmed in 16 participants with a history of cefazolin allergy, resulting in a meta-analytical frequency of 3.7%.

--The frequency of penicillin allergy was 4.4% for the 8 studies that exclusively assessed surgical patients allergic to cefazolin.

These findings suggest that most patients with a penicillin allergy history may safely receive cefazolin. The exception is patients with confirmed penicillin allergy in whom additional care is warranted.

Source: https://jamanetwork.com/journals/jamasurgery/article-abstract/2777647
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