Penicillin Allergy Pathway for Antibiotic Prescription in Patients With Penicillin Allergy Mild Reaction - Itching, Minor rash (not hives), Maculopapular rash (mild type IV HSR), EMR lists allergy, but patient denies • Use full-dose third-/fourth-generation cephalosporin OR • Use penicillin or first-/second- generation cephalosporin by Test Dose Procedure OR • Use carbapenem Type I (lgE-Mediated) HSR - Anaphylaxis, Angioedema, Wheezing, Laryngeal edema, Hypotension, Hives/urticaria OR Unknown reaction WITHOUT mucosal involvement, skin desquamation, or organ involvement • Use third-/fourth-generation cephalosporins or carbapenems by Test Dose Procedure OR • Use alternative agent by microbial coverage OR • Aztreonam • If infectious disease consult determines that penicillin or a first-/second- generation cephalosporin is the preferred therapy, or that one of the alternative agents is substandard, consult Allergy Type II-IV HSR - Serum sickness, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Acute interstitial nephritis, Drug rash eosinophilia systemic symptoms syndrome, Hemolytic anemia • Avoid using penicillin or cephalosporin; use alternative agents by microbial coverage • If there is a strong clinical indication for use of penicillin or cephalosporin, please involve the Allergy and Infectious Disease services #Penicillin #Allergy #Pathway #Antibiotics #Prescription #algorithm #management
