Guidelines
Beta-lactam Allergy - Safe Antibiotic Selection

Beta-lactam Allergy - Safe Antibiotic Selection

About this Tool

This algorithm can be used to select a non-cross reacting beta-lactam in patients with proven or presumed penicillin allergy.

Use of Tool

  • serious allergy to more than 2 unrelated beta-lactams

  • patient refuses a beta-lactam despite education

  • questions cannot be answered with a reasonable degree of certainty

Pregnancy does not alter the likelihood of reacting or cross-reacting to a beta-lactam

Most experts agree that pregnant patients should NOT be treated differently, especially when:

  • selecting non-cross reacting alternatives

  • in cases of intolerance

  • in cases of delayed reactions

Most clinicians use caution in Type I immediate reactions when considering the offending agent, and are generally uncomfortable challenging pregnant patients without testing

Ideally, if skin testing is indicated, this should be performed by an allergist or someone with experience

Evidence regarding Direct Challenges in pregnancy is lacking; most agree that it can be done in patients with low risk histories

Use the algorithm for any applicable specific guidance in pregnant patients