Are patients with beta-lactam allergies receiving inferior antibiotics?

Published Online: December 11, 2015

Beta-lactams are the first line treatment against many serious bacterial infections. Patients labeled as allergic to one of these antibiotics are often prescribed second line non-beta-lactams that can be more expensive, result in more adverse events and longer hospital stays.

In an original study recently published in The Journal of Allergy & Clinical Immunology (JACI), Jeffres et al. theorized that patients labeled as penicillin, cephalosporin, or carbapenem allergic treated with non-beta-lactams would have higher rates of clinical failure, but lower rates of allergic reactions, than patients treated with beta-lactams. They collected data on more than 500 hundred patients with gram negative bloodstream infections from three hospitals across the country.

Analysis of the data revealed that patients treated with non-beta-lactams did indeed have higher rates of clinical failure. The most common cause of clinical failure was a persistent temperature greater than 38.0°C after 3 days of antibiotic therapy. Unexpected findings of the study were the low number of new allergic reactions which occurred in 16 patients, less than 3% of the study population. Thirteen of the 16 patients were exposed to a beta-lactam.  

The authors conclude that patients with a history of beta-lactam allergies are more likely to experience treatment failure when treated with a non-beta-lactam and no less likely to experience a hypersensitivity reaction. The findings do not support the practice of avoiding all beta-lactam antibiotics for patients with an allergy to penicillins, cephalosporins, or carbapenems. While the use of an antibiotic in the same class of allergy should continue to be avoided, the authors suggest clinicians can utilize this data to improve clinical outcomes by providing the most appropriate antibiotics.

The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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