Assessing Need for Alternative Antibiotics in Children with β-Lactam Allergies

Penicillin Allergy – Assess nature of reaction based on Penicillin Allergy Pathway
Symptoms of Allergic Reaction	Recommended First-Line Antibiotic	Action
Reaction consistent with severe cutaneous adverse reaction (e.g., Stevens-Johnson, DRESS, erythema multiforme)	All penicillins, cephalosporins, and carbapenems	Use alternative recommendation
Reaction consistent with IgE-mediated allergy (e.g., hives, bronchospasm, swelling, anaphylaxis)	Penicillins (amoxicillin, ampicillin, piperacillin-tazobactam)	Use alternative recommendation
	Cephalexin	Anaphylaxis: use alternative recommendation All other IgE-mediated reactions: cephalexin
	Cefazolin, ceftazidime, ceftriaxone, or cefepime	Use first-line recommendation
	All carbapenems	Use first-line recommendation

Cephalosporin Allergy
Symptoms of Allergic Reaction	Recommended First-Line Antibiotic	Action
Reaction consistent with severe cutaneous adverse reaction (e.g., Stevens-Johnson, DRESS, erythema multiforme)	All penicillins, cephalosporins, and carbapenems	Use alternative recommendation
Reaction consistent with IgE-mediated allergy (e.g., hives, bronchospasm, swelling, anaphylaxis)	All cephalosporins	Use alternative recommendation, consider Allergy consult or clinic referral Allergy consult recommended for children with any allergy who require treatment with cephalosporins
	All penicillins (amoxicillin, ampicillin, piperacillin-tazobactam)	Anaphylaxis: use alternative recommendation All other IgE-mediated reactions: Use first-line recommendation
	All carbapenems	Use first-line recommendation

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.