Journal Article

The Safety of Aztreonam Versus Ceftazidime in Patients Labeled With Penicillin Allergy: A Cohort Study

Hung, Kai Chee, Kwa, Lay Hoon Andrea, Lim, Jia Le, Koomanan, Narendran, Tan, Jun Jie, Loo, Li Wen, Chua, Nathalie Grace Sy, Lim, Yun Chun Shena, Piotr, Chlebicki Maciej, Zhou, Peijun Yvonne, Lee, Hui Ling Winnie, Teoh, Boon San, Thien, Siew Yee, Cherng, Pei Zhi Benjamin, Yii, Yah Chieh Daphne, Lee, Lai Wei, Chung, Shimin Jasmine, Liew, Yixin

2024

Overview

•Ceftazidime is as safe as aztreonam in patients labelled with penicillin allergy.•Ceftazidime is more economical than aztreonam.•Penicillin allergy de-labelling to be considered for patients with unknown reaction.•Use ceftazidime, conserve broad-spectrum antibiotics, slow antimicrobial resistance. Penicillin allergy is the most common drug allergy among hospitalized patients. Traditionally, aztreonam is recommended for patients labeled with penicillin allergy (PLWPA) in our institutional empirical antibiotic guidelines. Due to a global aztreonam shortage in December 2022, the antimicrobial stewardship unit recommended ceftazidime as a substitute. There is a paucity of real-world data on the safety profile of ceftazidime in PLWPA. Hence, we evaluated tolerability outcomes of ceftazidime use in PLWPA. This retrospective cohort study compared PLWPA in Singapore General Hospital who received aztreonam (October 2022–December 2022) or ceftazidime (December 2022–February 2023). Patients were stratified according to their risk of allergic reaction (AR) based on history of penicillin allergy. The severity of AR was based on the Delphi study grading system. The primary outcome was development of AR after initiation of aztreonam or ceftazidime. The secondary tolerability outcomes include hepatotoxicity and neurotoxicity. There were 168 patients in the study; 69 were men (41.1%) and the median age was 69 years (interquartile range: 59–76 years). Incidence of AR was statistically similar in both arms: 1 of 102 patients (0.98%) in the aztreonam arm vs 2 of 66 patients (3.03%) in the ceftazidime arm (P = 0.33). The patient in the aztreonam arm was deemed at medium risk of having an AR and developed localized rashes (grade 1). Both patients in the ceftazidime arm were deemed at high risk of AR and developed localized skin reaction (grade 1). Hepatotoxicity was observed in 1 patient prescribed aztreonam. No patients in the ceftazidime arm developed adverse events. Ceftazidime appears to be better tolerated and cheaper compared with aztreonam in PLWPA, and serves as an antimicrobial stewardship strategy to conserve broader-spectrum antibiotics use.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Allergies / Anaphylaxis / Anti-Bacterial Agents - administration & dosage / Anti-Bacterial Agents - adverse effects / Antibiotics / Antimicrobial stewardship / Aztreonam / Aztreonam - administration & dosage / Aztreonam - adverse effects / Ceftazidime / Ceftazidime - administration & dosage / Ceftazidime - adverse effects / Ceftazidime - therapeutic use / Cohort analysis / Cohort Studies / Drug dosages / Drug Hypersensitivity - epidemiology / Drug Hypersensitivity - etiology / Economical / Female / Hepatotoxicity / Humans / Internal Medicine / Male / Middle Aged / Neurotoxicity / Patients / Penicillin / Penicillin allergy / Penicillins - adverse effects / Physicians / Retrospective Studies / Singapore / Skin / Tolerability