KAPALUA, HAWAII — Oral cefdinir is safe for the treatment of skin and soft-tissue infections in people who are allergic to penicillin, Dr. James Q. Del Rosso said in a poster presentation at the Winter Clinical Dermatology Conference, Hawaii.
Dr. Del Rosso reported that a review of the literature found virtually no cross-reactivity between cefdinir (Omnicef) and penicillin, despite concerns over the use of cephalo-sporins in patients with a history of penicillin allergy.
“All cephalosporin antibiotics are not created equal,” said Dr. Del Rosso, who has a private dermatology practice in Las Vegas.
He asserted that differences in the seven-position side chain structure of selected cephalosporins make cross-reactivity with penicillin less likely in second- and third-generation cephalosporins such as cefdinir.
“A thorough review of available data indicates that the frequently cited risk of 8%–18% cross-reactivity to cephalo-sporins among penicillin-allergic patients is not accurate, is misleading, and requires revision,” Dr. Del Rosso noted in his poster.
The increased risk of allergic reactions in penicillin-allergic patients is only 0.4% for first-generation cephalosporins and “nearly nil” for certain later-generation agents, which he defined as cefdinir, cefpodoxime, and cefuroxime.
“The one we use in dermatology [cefdinir] appears to have essentially no cross-reactivity with penicillin,” he said in an interview at the conference, which was sponsored by the Center for Bio-Medical Communications Inc.
Dr. Del Rosso noted that the American Academy of Pediatrics has endorsed the use of cefdinir, cefpodoxime, and cefuroxime in penicillin-allergic children, excluding those who have had life-threatening reactions such as anaphylaxis or toxic epidermal necrolysis.
He added that the American Academy of Family Physicians has taken a similar position.
“The risk of anaphylaxis associated with cephalosporin use has been cited to range from 0.1% to 0.0001%, with no cases of fatal anaphylaxis reported in children,” according to the poster.
Medicis provided support for the production of the poster.
Dr. Del Rosso is a consultant to, and serves on the speakers' bureau of, Abbott Laboratories, which makes Omnicef.