Penicillin allergy and surgical prophylaxis: Cephalosporin cross-reactivity risk in a pediatric tertiary care center

J Pediatr Surg. 2015 May;50(5):856-9. doi: 10.1016/j.jpedsurg.2014.10.048. Epub 2014 Dec 12.


Background: First generation cephalosporins are commonly used as antibiotic prophylaxis prior to surgery. Patients labeled as penicillin-allergic are often precluded from receiving cephalosporins because of an allergic cross-reactivity. The aims of this study were to evaluate the clinical practice for surgical prophylaxis at Nationwide Children's Hospital and to determine the incidence of adverse effects and allergic reactions when using cephalosporins in patients labeled as penicillin-allergic.

Methods: A retrospective chart review was performed to identify patients who were allergic to penicillin, penicillin antibiotic family, who required surgical treatment for an existing medical condition, and received an antibiotic to prevent surgical site infection.

Results: Five hundred thirteen penicillin-allergic patients were identified, encompassing 624 surgical cases. Cephalosporins were administered in 153 cases (24.5%) with cefazolin used 83% of the time. Only one documented case of nonanaphylactic reaction was reported. Clindamycin was the most common cephalosporin substitute (n=387), and the reported adverse reaction rate was 1.5%. No cases of anaphylaxis were documented.

Conclusions: Our data suggest that the administration of cephalosporins for surgical prophylaxis following induction of anesthesia in a patient with a known or reported penicillin-allergy appears appropriate and results in a lower adverse event rate that when clindamycin is administered.

Keywords: Cephalosporin; Cross-reactivity; Pediatrics; Penicillin allergy; Surgical prophylaxis.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis / methods*
  • Cephalosporins / therapeutic use*
  • Child
  • Child, Preschool
  • Drug Hypersensitivity / epidemiology*
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Female
  • Hospitals, Pediatric
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Penicillins / adverse effects*
  • Preoperative Care / methods*
  • Retrospective Studies
  • Tertiary Care Centers*
  • United States / epidemiology


  • Anti-Bacterial Agents
  • Cephalosporins
  • Penicillins