Penicillin allergy
Penicillins are life-saving antimicrobials and patients should not be labelled ‘penicillin-allergic’ without careful consideration.
Severe/life-threatening penicillin allergy:
- e.g. anaphylaxis, angioedema, facial/throat swelling, or history of urticaria or rash immediately after penicillin administration.
- Severe/life-threatening reactions are rare. A reliable history is key.
- Avoid cephalosporins and meropenem. Instead consult Microbiology/ID for advice.
Allergy description
|
Characteristics |
Type 1 immediate reactions |
Non-Type 1 reactions |
|
Timing of onset |
Usually 1 to 4 hours from exposure (up to 72 hours) |
More than 72 hours from exposure |
|
Clinical signs
|
Anaphylaxis |
Maculopapular rash |
Allergy severity assessment
|
History of clinical signs of: |
Antibacterial colour-coding |
|
|
Severe/
|
Type 1 immediate hypersensitivity or Severe non-Type 1 reactions Toxic Epidermal Necrolysis (TEN). |
RED drugs are contra-indicated unless recommended by Microbiology/ID or Immunology in a specific patient. ORANGE drugs are NOT for use, unless at the discretion of Microbiology/paeds ID. GREEN drugs are considered safe. |
|
Non-severe |
Mild to Moderate non-Type 1 reactions |
RED drugs are NOT for use, unless no alternative and benefit outweighs risk. (Seek Microbiology/ paeds ID advice). ORANGE drugs can be used with caution. If in doubt, discuss with Microbiology/paeds ID. GREEN drugs are considered safe. |
Penicillin allergy risk colour-coding
|
Red |
Orange |
Green |
|
|
amoxicillin benzylpenicillin (penicillin G) co-amoxiclav (Augmentin®) (amoxicillin+clavulanic acid) flucloxacillin penicillin V (phenoxymethylpenicillin) procaine benzylpenicillin piperacillin+tazobactam (Tazocin®) pivmecillinam temocillin
|
aztreonam* cefalexin cefazolin cefotaxime cefoxitin ceftaroline ceftazidime ceftazidime-avibactam (Zavicefta®) ceftolozane-tazobactam (Zerbaxa®) ceftriaxone cefuroxime ertapenem* Primaxin®- imipenem with cilastatin* Recarbrio® - imipenem, cilastatin and relebactam* meropenem* meropenem-varbobactam* |
amikacin azithromycin chloramphenicol ciprofloxacin clarithromycin clindamycin colistimethate sodium co-trimoxazole dalbavancin daptomycin doxycycline erythromycin fosfomycin gentamicin levofloxacin linezolid |
metronidazole minocycline moxifloxacin neomycin nitrofurantoin ofloxacin oxytetracycline pristinamycin rifampicin sodium fusidate (fusidic acid) teicoplanin tetracycline tigecycline tobramycin trimethoprim vancomycin
|
*These antibiotics may be recommended by Micro/ID for certain patients with penicillin allergy, always consult Micro/ID before using