Latest news with #beta-lactam
Medscape
4 days ago
- General
- Medscape
Cefazolin in Joint Surgery Safe Despite Antibiotic Allergy
For patients with beta-lactam allergy undergoing orthopedic surgery, prioritizing cefazolin as the preferred antibiotic for the prevention of surgical site infections (SSIs) did not lead to any probable hypersensitivity reactions, even among patients with a history of severe beta-lactam allergies. METHODOLOGY: Past practice had called for avoiding the use of cefazolin in patients with beta-lactam allergy, but this approach left patients at greater risk for SSIs. Newer studies established that cefazolin could be a safe option for these patients after all. Researchers conducted a retrospective review to evaluate the safety of a quality improvement protocol that recommended adopting cefazolin for SSI prophylaxis in patients allergic to beta-lactams — excluding those with a documented allergy to cefazolin. The analysis included 521 patients (average age, 58 years; 67.56% women) with a documented penicillin or cephalosporin allergy who underwent an elective orthopedic surgery. All the patients received a weight-based cefazolin dose within 60 minutes of incision, which was repeated every 8 hours postoperatively until discharge or to a maximum of three doses. TAKEAWAY: None of the patients met the criteria for probable intraoperative hypersensitivity reactions. Twenty-four patients experienced intraoperative hemodynamic instability within 5 minutes of receiving the drug, but 14 of these patients received subsequent doses and did not experience further hemodynamic changes. The other 10 patients did not receive additional doses. No patient required intraoperative epinephrine or diphenhydramine or was labeled as allergic to cefazolin. IN PRACTICE: 'We recommend adopting cefazolin as the standard of care for SSI prophylaxis in orthopedic surgeries, regardless of beta-lactam allergy history or severity, while excluding only those who had a documented cefazolin-specific allergy,' the authors wrote. SOURCE: Zachary Clarke, MD, with the Anderson Orthopaedic Research Institute in Alexandria, Virginia, was the first author of the study, which was published online on May 22 in The Journal of Arthroplasty. LIMITATIONS: The limitations of the study were retrospective study design and the simultaneous use of other medications that can cause hypotension, the researchers noted. Future studies could validate the findings and consider other types of surgery, they wrote. DISCLOSURES: The authors reported having no conflicts of interest.
Medscape
4 days ago
- General
- Medscape
Beta-Lactam Allergy De-Labeling Safe, Effective in Seniors
Beta-lactam allergy de-labeling was safe and effective for older adult patients, successfully removing false allergy labels in 87.3% of cases, with no patients requiring hospitalization or adrenaline administration. METHODOLOGY: Researchers conducted a decade-long retrospective analysis to evaluate the safety and efficacy of beta-lactam allergy evaluations in older adult patients previously labeled as allergic. The analysis included 166 older adult patients (mean age, 71 years; 72.9% women) who were evaluated between 2009 and 2019 for suspected beta-lactam allergy. All participants underwent comprehensive anamnesis, skin testing, and, when indicated, an oral challenge; those who were successfully de-labeled underwent long-term follow-up to monitor beta-lactam use and outcomes. TAKEAWAY: Beta-lactam allergy was ruled out in 87.3% of patients; 9.6% had immediate-type hypersensitivity reactions, 2.4% had severe delayed-type hypersensitivity reactions, and 0.6% experienced a benign rash. No participant required hospitalization or emergency adrenaline treatment during the evaluation. In a long-term follow-up (3-13 years) of 106 patients, 35.8% were treated with the previously suspected beta-lactam agent, and no immediate-type or severe delayed-type hypersensitivity reactions were reported. IN PRACTICE: 'Increased awareness is crucial for enhancing allergic workup in the geriatric population bearing beta-lactam allergy labels,' the authors wrote. 'We believe that establishing the removal rate of false BL [beta-lactam] allergy labels as a healthcare quality metric and making it mandatory under the supervision of health authorities will improve outcomes for both the general population and the geriatric population,' they added. SOURCE: Saray Sity-Harel, MD, with Tel-Aviv University, Tel-Aviv, Israel, was the corresponding author of the study, which was published online in Journal of Clinical Medicine . LIMITATIONS: This study had a single-center design and limited patient follow-up data, which may reduce the generalizability of the findings and the validity of the outcomes. DISCLOSURES: The authors reported having no conflicts of interest.
