Cefdinir for Streptococcal Infection in Patients with Penicillin Allergy
Treatment Recommendations Based on Allergy History
- The American Academy of Family Physicians recommends first-generation cephalosporins, such as cefazolin or cephalexin, over third-generation cephalosporins like cefdinir for patients with non-severe penicillin allergies 1, 2
- Cefdinir can be used safely in patients with non-severe, non-immediate reactions to penicillin, according to the Infectious Diseases Society of America 2
- For patients with history of anaphylaxis, angioedema, respiratory distress, or urticaria following penicillin administration, the Centers for Disease Control and Prevention consider them high-risk for cross-reactivity with cephalosporins 3, 4
- The American Academy of Family Physicians recommends clindamycin as an alternative for high-risk patients, if the isolate is susceptible 1, 2
- If clindamycin cannot be used, macrolides, such as clarithromycin or azithromycin, are appropriate alternatives, according to the Infectious Diseases Society of America 1, 2
Important Clinical Considerations
- The risk of cross-reactivity between penicillins and cephalosporins is lower than previously thought, especially with later-generation cephalosporins that have dissimilar side chains, as reported by the Infectious Diseases Society of America 2
Common Pitfalls to Avoid
- The Centers for Disease Control and Prevention advise against using cefdinir in patients with documented anaphylactic reactions to penicillin without proper allergy evaluation 3, 4
- The Infectious Diseases Society of America recommends avoiding the use of cephalosporins with similar side chains to penicillin in patients with severe penicillin allergies 2