Safety of Cefazolin Test Dose in Patients with Penicillin Allergy Just Prior Cardiac Device Implantation: A Single Center Experience.

Abstract

Introduction

Cephalosporins are the cornerstone of cardiac device infection prophylaxis. In fear of cross reactivity, penicillin allergic patients are exposed to potentially more toxic drugs and decrease in efficacy. We evaluated the safety of a cefazolin test dose (CTD) in self-reported penicillin allergic patients.

Methods

In this single center study, we evaluated consecutive patients with chart documentation of penicillin allergy undergoing cardiac device implantation over a 2-year period. A CTD was performed if there was no documented cephalosporin allergy or reported severe anaphylactic reaction to penicillin. Patients were given 2 doses of cefazolin 100 mg IV, and if no allergic reaction occurred after 5 minutes, the full dose (1,800 mg) was administered in the electrophysiology laboratory just before the procedure.

Results

A total of 2,200 patients were included. The frequency of reported penicillin allergy was 9.3% (n = 204). In 80% of cases, the type of allergic reaction was not reported in medical notes or unknown by the patient. A CTD was performed in 67.6% of patients with penicillin allergy (n = 138). We found 5 adverse events (3.6% [95% CI, 1.1%-6.1%]): 4 skin rashes and one tongue edema. These 5 patients became asymptomatic after antihistaminic and corticosteroid IV treatment. Even if the test dose was negative, 79% of patients were also administered vancomycin before the procedure since it requires a 1-hour infusion prior to the CTD in the implant room.

Conclusion

Cefazolin test dose in most penicillin allergic patients appears safe and allows its use per recommended guidelines.