DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20212533

Cephalosporin graded challenges approach in community–acquired pneumonia patient with a history of penicillin allergy

Ketut Suryana

Abstract


Community-Acquired Pneumonia (CAP) is an acute pulmonary parenchyma infection that acquired in the community. Diagnosis based on clinical manifestations, chest X-ray (CXR) and microbiological diagnosis test (lung aspirates culture). Recently there was advance in antimicrobial treatments of CAP and a microbiological diagnostic test is essential to ensure antimicrobial treatments. In the other hand microbiological diagnostic test does not achieve all of the pneumonic cases. Therefore, antimicrobial treatment should be empirically performed to avoid the delay in establishing appropriate treatment related with the mortality. By administering combination antimicrobial will achieve a better outcome than a mono-therapy. For patients with history of penicillin allergy, though the risk of cephalosporin allergic cross-reactivity is low, a greater awareness is still needed, so a graded challenge approach could be considered. Herein we present a case report of a female, 20-year-old, hospitalized due to CAP, and also had a history of penicillin allergy. She was treated by levofloxacin 750 mg IV q 24 hour and cephalosporin (ceftriaxone) 1 g IV q 12 hour with a Graded challenge approach. Although it does not a novelty, we hope it would remind the health care that a Graded challenge could be considered as an approach of administering cephalosporin in patient who has an experiece of penicillin allergy.  


Keywords


A Community-acquired pneumonia, Penicillin allergy, Allergic cross-reactivity, Graded challenge approach

Full Text:

PDF

References


Cilloniz C, Martin-Loeches I, Garcia-Vidal C, San Jose A, Torres A. Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns. Int J Mol Sci. 2016;17(12):2120.

Akter, S. Community Acquired Pneumonia. Int J Respir Pulm Med. 2015;2.

Lutfiyya MN, Henley E, Chang LF, Reyburn SW. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006;73(3):442-50.

Pongdee T, Li JT. Evaluation and Management of Penicillin Allergy. Mayo Clin Proc. 2018;93(1):101-7.

Gonzalez-Estrada A, Radojicic C. Penicillin allergy: A practical guide for clinicians. Cleve Clin J Me. 2015;82(5):295-300.

Lim WS, Smith DL, Wise MP on behalf of the British Thoracic Society. British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline: how they fit together. BMJ Open Respiratory Research. 2015;2:e000091.

Devchand M, Trubiano JA. Penicillin allergy: a practical approach to assessment and prescribing. Aust Prescr. 2019;42(6):192-9.

Yuson CL, Katelaris CH, Smith WB. 'Cephalosporin allergy' label is misleading [published correction appears in Aust Prescr 2018;41(6):205]. Aust Prescr. 2018;41(2):37-41.

Kim MH, Lee JM. Diagnosis and management of immediate hypersensitivity reactions to cephalosporins. Allergy Asthma Immunol Res. 2014;6(6):485-95.

Abrams EM, Khan DA. Diagnosing and managing drug allergy. CMAJ. 2018;190(17):E532-8.

Khan DA, Solensky R. Drug allergy. J Allergy Clin Immunol. 2010;125(Suppl 2):S126-37.

Pourpak Z, Fazlollahi MR, Fattahi F. Understanding adverse drug reactions and drug allergies: principles, diagnosis and treatment aspects. Recent Pat Inflamm Allergy Drug Discov. 2008;2(1):24-46.