Cefuroxime Administration in Patients with Amoxicillin Allergy

Introduction to Cefuroxime Safety

The American College of Allergy, Asthma, and Immunology recommends that cefuroxime can be safely administered to patients with amoxicillin allergy without prior testing in most cases, because cefuroxime has a different R1 side chain structure than amoxicillin, making cross-reactivity extremely unlikely 1

Cross-reactivity between penicillins and cephalosporins is primarily determined by similarity of the R1 side chain structure, not the beta-lactam ring itself, according to the British Society for Allergy and Clinical Immunology 2, 1
The overall risk of cross-reactivity between penicillins and second-generation cephalosporins is estimated at only 2-5% in patients with true penicillin allergy, and even lower with dissimilar side chains, as reported by the British Journal of Anaesthesia 3

The Journal of Allergy and Clinical Immunology recommends direct administration of cefuroxime without prior testing when the amoxicillin reaction was non-anaphylactic 4, 2
Patients with suspected immediate-type or delayed-type non-severe allergy to amoxicillin can safely receive cefuroxime regardless of the severity or time since the allergic reaction, according to Praxis Medical Insights 1
If the amoxicillin reaction was anaphylaxis, the American Academy of Allergy, Asthma, and Immunology recommends cephalosporin skin testing should be performed before administering parenteral cefuroxime 2

The American College of Allergy, Asthma, and Immunology states that this recommendation does NOT apply to severe delayed reactions, such as Stevens-Johnson syndrome, Toxic epidermal necrolysis, DRESS, Drug-induced liver injury, Acute interstitial nephritis, and Hemolytic anemia, which require allergy specialist consultation 2

The recommended skin testing concentration for cefuroxime is 90 mg/mL for prick/puncture testing, and 1 mg/mL and 10 mg/mL for intradermal testing, as recommended by Praxis Medical Insights 2
If skin testing is negative, a graded drug challenge to cefuroxime is still advised before full-dose administration, according to the Journal of Allergy and Clinical Immunology 4