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David F. Butler et al
Fig. 1. Antibiotic prophylaxis exposure based on penicillin allergy classification and associated perioperative adverse drug reactions (ADR).
more frequently in ADR(+) patients who received vancomycin or alternative cephalosporins. Thus, data also highlight the find- ing that cefazolin alternatives are associated with a potential increased risk for perioperative ADEs. Our study has several limitations. The findings are limited to a
single pediatric institution and therefore may not be generalizable. This study was retrospective in nature, and perioperative ADEs were documented based on ICD-9-CM and E codes. Conversely, ICD-9-CM and E codes have proven effective in identifying ADEs in hospitalized patients, including surgical patients.11,12 The selected codes were likely not all-inclusive for antibiotic-associated ADEs and could have resulted in an underrepresentation of ADEs. Attributing a perioperative ADE specifically to an anti- biotic is difficult without subsequent drug rechallenge or skin testing. Most of the documented penicillin ADRs were unknown in severity, which made it challenging to determine whether cefazolin would be indicated using ADR label alone. Notably, a review of the surgical procedures included in our study’s patient population revealed that many do not routinely require antibiotic prophylaxis (ie, circumcision, tympanoplasty). This finding highlights the lack of standardization for routine antibiotic pro- phylaxis and demonstrates that additional work is needed to limit antibiotic exposure and ADE risk for procedures without pro- phylaxis indications. Regardless, our data strongly indicate that perioperative antibiotic prescribing is highly variable among children with a documented penicillin ADR. Further research is needed to optimize clarification and interpretation of an ADR history to safely standardize care, to provide the antibiotic of choice when possible, and to utilize a safe alternative when truly needed. In conclusion, our study demonstrates that surgical AP varies significantly in children with documented penicillin ADRs resulting in the unnecessary use of alternative antibiotics that result in higher rates of perioperative ADEs. Further work is needed to standardize AP selection in those labeled penicillin
allergic and minimize the avoidance of cefazolin in cases when it can be safely administered.
Acknowledgments.
Financial support. All authors report no financial support relevant to this article to disclose.
Conflicts of interest. All authors report no conflicts of relevant to this article to disclose.
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