Perioperative antibiotic prophylaxis in adults - Sistema Nazionale ...

• exanthema (rash)Other less specific symptoms are either not associated or only weakly associated witha subsequent allergic reaction.Patients should not be given any antibiotic or class of antibiotics to which they havehad a past adverse reaction.RecommendationsIV/B Patients with a history of anaphylaxis, urticaria or exanthema (rash)immediately following treatment with penicillin are at greater risk of immediatehypersensitivity and should not be given prophylaxis with beta-lactams.# Whenever the guidelines for surgical antibiotic prophylaxis recommend a betalactamantibiotic as first-line agent, an alternative for patients with an allergy topenicillins or cephalosporins should always be recommended.Intrinsic toxicity of antibiotics and possible cross-reactivityThe chosen antibiotic must be one of those with the most advantageous risk-benefitratios; where two or more drugs are equally effective, the one least likely to causeorganic disease or to cross-react with other drugs administered to the patient, inparticular those used for anaesthesia, must be chosen 1,23,27 .If the chosen antibiotic is one that can cross-react with other therapeutic drugscurrently being administered, the dosage should be adjusted accordingly.Evidence-based effectiveness and effects on the environmentNumerous RCTs in recent years have demonstrated that antibiotics are more effectivethan a placebo in preventing postoperative infections.The first to be proved effective were the first- and second- generation cephalosporins,penicillins, lincosamides and aminoglycosides, particularly gentamicin. More recentstudies have demonstrated the efficacy in prophylaxis of antibiotics normally used in