| ENDA |
| SCARs, generalised bullous FDE, severe MPE, linear IgA bullous dermatosis, systemic vasculitides, organ involvement/cytopenia, penicillin-induced autoimmune disease | avoid using Penicillins/Cephalosporins OR use non-BL antibiotics by microbial coverage OR use, upon graded challenge, Aztreonam, Carbapenems, 3rd/4th/5th generation Cephalosporins |
|
| anaphylaxis, hypotension, laryngeal oedema, bronchospasm, urticaria or angioedema, generalised angioedema | avoid using Penicillins/Cephalosporins OR use non-BL antibiotics by microbial coverage OR use, upon graded challenge, Aztreonam, Carbapenems, 3rd/4th/5th generation Cephalosporins |
|
| NIR: contact dermatitis, systemic contact dermatitis, local reaction (i.m. administration), exfoliative palmar dermatitis, FDE, delayed urticaria, mild or moderate MPE, symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) OR IR: isolated generalised pruritus which did not require treatment, isolated digestive symptoms, localised urticaria OR unknown reactions | avoid using Penicillins/Cephalosporins OR use full-dose Aztreonam, Carbapenems, 3rd/4th/5th generation Cephalosporins OR use non-BL antibiotics by microbial coverage |
| Blumenthal |
| Stevens-Johnsons syndrome, Toxic Epidermal Necrolysis, Acute interstitial Nephritis, Drug Rash Eosinophilia with Systemic Symptoms (DRESS), haemolytic anaemia | avoid using Penicillins/Cephalosporins, and Carbapenems AND use alternative agents by microbial coverage; |
|
| anaphylaxis, angioedema, wheezing, laryngeal oedema, hypotension, hives/urticaria OR unknown reactions with no further details available from patient/proxy | avoid using the penicillin subclass OR use 3rd/4th/5th generation Cephalosporins by test dose procedure OR use alternative agent by microbial coverage OR use Aztreonam or Carbapenems |
|
| MPE, or minor rash (not hives), EHR mention but patient denies, unknown reaction, but patient denies mucosal involvement, skin desquamation, organ involvement, or need for medical evaluation | use full dose Cephalosporins OR use Penicillin by test dose procedure OR use Carbapenems |
| Schrüfer |
| chronology of up to 30 minutes from exposure to reaction and a semiology of urticaria or anaphylaxis. signs and symptoms of anaphylaxis occurrence during general anaesthesia mucous membrane erosions/skin bullae hepatic or renal involvement or cytopenia | If answer is Yes/Uncertain – USE ALTERNATIVE ANTIBIOTIC |
|
| measles-like rash or MPE occurring during or within one week of penicillin exposure? | If answer is Yes – USE ALTERNATIVE ANTIBIOTIC (as for high-risk subjects) |
|
| acute urticaria with or without angioedema during penicillin exposure which reoccurs for several days after treatment is stopped? | If answer is Yes – DELABEL |
|
| skin symptoms such as urticaria and MPE only developed during or immediately after stopping penicillin exposure occurring during childhood or adolescence (less than 16 years)? | If answer is Yes – DELABEL |
|
| symptoms reported are not compatible with a hypersensitivity reaction – gastrointestinal symptoms, cephalea, palpitation? chronology between exposure and symptom onset not suggestive of hypersensitivity – urticaria >2 days after the last dose; MPE >7 days after the last dose? | If answer is Yes – DELABEL |
