Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

D. Side Chains1.2.5. The prescriber and pharmacist should determine the next course ofaction:1.2.5.1. Use an antibiotic from another class.1.2.5.2. Initiate a graded challenge (see section E) if the risk ofreaction is felt to be low.1.2.5.3. Penicillin skin testing.1.2.5.3.1. Patients with a history of severe, non-IgE mediatedreactions should not be skin tested.1.0 If the order is for a beta-lactam antibiotic that has the same side chain as the antibioticthe patient is allergic to, the prescriber should be contacted for another antibiotic choicedue to increased risk of cross-reactivity. 4,14-16 Cefazolin does not share a common sidechain with any other beta-lactams. 14 The following table lists beta-lactams with commonside chains:Agent Agents with Common Side ChainsAmoxicillin Ampicillin Cefaclor Cefadroxil Cefprozil Cephalexin CephradineAmpicillin Amoxicillin Cefaclor Cefadroxil Cefprozil Cephalexin CephradineAztreonam CeftazidimeCefaclor Amoxicillin Ampicillin Cefadroxil Cefprozil Cephalexin CephradineCefadroxil Amoxicillin Ampicillin Cefaclor Cefprozil Cephalexin CephradineCefamandole CefotetanCefdinir CefiximeCefepime Cefotaxime Cefpodoxime Ceftizoxime CeftriaxoneCefixime CefdinirCefotaxime Cefepime Cefpodoxime Ceftizoxime Ceftriaxone CephalothinCefotetan CefamandoleCefoxitin Cefuroxime Cephalothin Penicillin GCefpodoxime Cefepime Cefotaxime Ceftizoxime CeftriaxoneCefprozil Amoxicillin Ampicillin Cefaclor Cefadroxil Cephalexin CephradineCeftazidime AztreonamCeftibuten CeftizoximeCeftizoxime Cefepime Cefotaxime Cefpodoxime Ceftibuten CeftriaxoneCeftriaxone Cefepime Cefotaxime Cefpodoxime CeftizoximeCefuroxime CefoxitinCephalexin Amoxicillin Ampicillin Cefaclor Cefadroxil Cefprozil CephradineCephalothin Cefotaxime Cefoxitin Penicillin GCephradine Amoxicillin Ampicillin Cefaclor Cefadroxil Cefprozil CephalexinPenicillin G Cefoxitin CephalothinE. Graded Challenge1.0 A graded challenge is cautiously administering a medication to a patient who is unlikely tobe allergic to it. It does not entail modification of the immune response. Since lowerdoses are initially used, if an allergic reaction happens, hopefully it will be minor andeasily treated. Patient’s should have beta-blockers discontinued to prevent treatmentresistant anaphylaxis if it occurs. 2,7,11Procedure: give 1%, then 10%, then 100% of therapeutic dose at 30 minute intervals if noreaction develops at each dosage increment1.1.1 If a reaction develops, the patient should be desensitized