Oluwaniyi V Eke¹*, Umair R Arain² and Achim R Nestel¹

¹Department of Ophthalmology, Royal Devon University Hospitals NHS Foundation Trust, Barnstaple, UK
²Clinical Fellow, Department of Ophthalmology, James Paget University Hospital, UK

*Corresponding Author: Oluwaniyi V Eke, Department of Ophthalmology, Royal Devon University Hospitals NHS Foundation Trust, Barnstaple, UK.

Received: August 16, 2023; Published: August 31, 2023

Abstract

Purpose: To establish the incidence of anaphylactic reaction to intraoperative cefuroxime in patients with a self-reported penicillin allergy during cataract surgery.

Setting: Clinical practice in North Devon District Hospital, Barnstaple, United Kingdom.

Design: Retrospective.

Methods: It included patients who underwent cataract surgery between March 2009 and March 2020. The details of their demography, procedure carried out, record of allergies, intra-op medication were extracted from the EMR. The main outcome measures were post op allergic reaction; urticarial or anaphylactic. The data was analyzed on Microsoft Excel.

Results: Overall 15764 eyes had cataract surgery between March 2009 and March 2020. 1764 [11%] of these were reported to be allergic to penicillin and 1652 [93.6%] still received intraoperative cefuroxime (intracameral +/- subconjunctival) despite their history of penicillin allergy. None of these 1652 patients developed any anaphylactic reaction.

Conclusion: Intra-operative cefuroxime during cataract surgery was well tolerated in patients with self-reported penicillin allergy in this large patient cohort. No post-operative anaphylaxis was observed.

 Keywords: Cataract Surgery; Cefuroxime; Cephalosporins; Penicillin Allergy; Anaphylaxis

References

1. Taban M., et al. “Acute endophthalmitis following cataract surgery: a systematic review of the literature”. Archives of Ophthalmology5 (2005): 613-620.
2. Montan PG., et al. “Prophylactic intracameral cefuroxime: efficacy in preventing endophthalmitis after cataract surgery”. Journal of Cataract and Refractive Surgery6 (2002): 977-981.
3. Colleaux KM and Hamilton WK. “Effect of prophylactic antibiotics and incision type on the incidence of endophthalmitis after cataract surgery”. Canadian Journal of Ophthalmology7 (2000): 373-378.
4. Barry P., et al. “ESCRS Guidelines on prevention, investigation and management of post-operative endophthalmitis”. Version 2 (2007): 14.
5. Pegler S and Healy B. “In patients allergic to penicillin, consider second and third generation cephalosporins for life threatening infections”. British Medical Journal7627 (2007): 991-991.
6. Pichichero ME. “A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients”. Pediatrics4 (2005): 1048-1057.
7. Petz LD., et al. “Coombs-positive hemolytic anemia caused by penicillin administration”. The New England Journal of Medicine4 (1966): 171-178.
8. Dash CH. “Penicillin allergy and the cephalosporins”. Journal of Antimicrobial Chemotherapy3 (1975): 107-118.
9. Herbert ME., et al. “Ten percent of patients who are allergic to penicillin will have serious reactions if exposed to cephalosporins”. Western Journal of Medicine5 (2000): 341.
10. LaHood BR., et al. “Antibiotic prophylaxis in cataract surgery in the setting of penicillin allergy: A decision-making algorithm”. Survey of Ophthalmology5 (2017): 659-669.
11. Pichichero ME and Casey JR. “Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis”. Otolaryngology Head and Neck Surgery3 (2007): 340-347.
12. Terico AT and Gallagher JC. “Beta-lactam hypersensitivity and cross-reactivity”. Journal of Pharmacy Practice6 (2014): 530-544.
13. Myneni J., et al. “Reduction in postoperative endophthalmitis with intracameral cefuroxime”. Journal of Hospital Infection4 (2013): 326-328.
14. Shorstein NH., et al. “Decreased postoperative endophthalmitis rate after institution of intracameral antibiotics in a Northern California eye department”. Journal of Cataract and Refractive Surgery1 (2013): 8-14.
15. Barreau G., et al. “Intracameral cefuroxime injection at the end of cataract surgery to reduce the incidence of endophthalmitis: French study”. Journal of Cataract and Refractive Surgery8 (2012): 1370-1375.
16. Moisseiev E and Levinger E. “Anaphylactic reaction following intracameral cefuroxime injection during cataract surgery”. Journal of Cataract and Refractive Surgery9 (2013): 1432-1434.
17. Villada JR., et al. “Severe anaphylactic reaction after intracameral antibiotic administration during cataract surgery”. Journal of Cataract and Refractive Surgery3 (2005): 620-621.
18. Campagna JD., et al. “The Use of Cephalosporins in Penicillin-allergic Patients: A Literature Review”. Journal of Emergency Medicine5 (2012): 612-620.
19. Idsoe O., et al. “Nature and extent of penicillin side-reactions, with particular reference to fatalities from anaphylactic shock”. Bulletin of the World Health Organization2 (1968): 159.
20. Solensky R. “Allergy to β-lactam antibiotics”. The Journal of Allergy and Clinical Immunology6 (2012): 1442-1442.
21. Annè S and Reisman RE. “Risk of administering cephalosporin antibiotics to patients with histories of penicillin allergy”. Annals of Allergy, Asthma and Immunology2 (1995): 167-170.
22. Mitra A and McElvanney A. “Prophylactic subconjunctival cefuroxime during cataract surgery in patients with a penicillin allergy”. The Annals of Ophthalmology4 (2006): 293-295.
23. Lehmann OJ., et al. “Association between nonadministration of subconjunctival cefuroxime and postoperative endophthalmitis”. Journal of Cataract and Refractive Surgery6 (1997): 889-893.
24. Group IRFS. “Allergic reactions to long-term benzathine penicillin prophylaxis for rheumatic fever”. The Lancet8753 (1991): 1308-1310.

Citation

Citation: Oluwaniyi V Eke., et al. “Intraoperative Cefuroxime in Penicillin Allergy During Cataract Surgery".Acta Scientific Ophthalmology 6.9 (2023): 55-59.

Copyright

Copyright: © 2023 Oluwaniyi V Eke., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.