Algorithm to identify patients at low risk

for penicillin/beta-lactam allergy

This patient is likely allergic to beta-lactam antibiotics.

With subsequent exposure, similar, or worse reactions may occur.

They must avoid this medication until assessed by an allergist.

Describe the Clinical circumstances for this patient:

This is on the patients medical record. Patient is not anticipated to require beta-lactam medications in the near future (low priority)

This patient has a complex medical condition that requires the frequent use of antibiotics (high priority)

• Recurrent UTI’s

• Cancer

• Recurrent otitis media

• Cystic fibrosis

• Need for antibiotic prophylaxis

• Multiple surgeries

• Primary immunodeficiency

• Immunosupressed patient

• Medically complex patient with high risk of admission for rule out pneumonia (or other infections)

This patient needs penicillin within 24 hours (Stat priority)

This patient has, or is suspected to have a severe infection in which a penicillin antibiotic is the best possible treatment with no acceptable alternative. A consult to infectious diseases has already indicated a penicillin is the best treatment option.

Clinical Pearls:

Cefazolin can be safely used in patients even with anaphylactic penicillin allergy. Avoid beta-lactams only if history of severe cutaneous adverse reactions (Steven Johnson’s/ Toxic epidermal necrolysis or DRESS). 

If the patient requires broader coverage, meropenem can be safely administered.