ReviewThe Journal of the American Academy of Orthopaedic Surgeons2022
Understanding Penicillin Allergy, Cross-reactivity, and Antibiotic Selection in the Preoperative Setting.
Review in The Journal of the American Academy of Orthopaedic Surgeons, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prehospital Antibiotic Administration for Suspected Open Fractures: Joint COT/OTA/ACEP/NAEMSP/NAEMT Position Statement.Prehospital emergency care · 2024Guideline
- The Pragmatic Removal of Penicillin Allergy Electronic Health Record Labels (PROPEL) Trial: A Randomized Clinical Trial.The journal of allergy and clinical immunology. In practice · 2025Trial
- Guideline-concordant cefazolin prophylaxis in penicillin allergy labeled arthroplasty patients: Progress and persistent barriers.Journal of clinical orthopaedics and trauma · 2026Article
- Penicillin Allergy Delabeling: Bridging the Evidence-Practice Gap in Antimicrobial Stewardship.Journal of general internal medicine · 2026Review
- Maternal and Microbiological Outcomes in GBS-Positive Patients Receiving Intrapartum Ampicillin versus Clindamycin: A Retrospective Cohort Study.Gynecologic and obstetric investigation · 2026Article
- Preoperative antibiotic prophylaxis in primary shoulder arthroplasty patients: a systematic review.JSES international · 2025Review
- Antibiotic Prescription in Dentistry: Trends, Patient Demographics, and Drug Preferences in Germany.Antibiotics (Basel, Switzerland) · 2025Article
- Evaluation of cephalosporin allergy: Survey of drug allergy experts.The journal of allergy and clinical immunology. Global · 2025Article
- Cefazolin versus alternative antibiotics for perioperative prophylaxis in patients labeled as cephalosporin allergic.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines.Journal of personalized medicine · 2024Review
- Pre-Operative Management of the Penicillin Allergic Patient: A Narrative Review.Orthopedic reviews · 2024Article
- Antibiotic use in spine surgery: A narrative review based in principles of antibiotic stewardship.North American Spine Society journal · 2023Article
- The association between penicillin allergy and surgical site infection after orthopedic surgeries: a retrospective cohort study.Frontiers in cellular and infection microbiology · 2023Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
Penicillin allergies are reported by 8% to 15% of the US population, but up to 95% of these allergies do not correspond to a true allergy when tested. Recent studies have demonstrated that having a penicillin allergy label (PAL) results in a 50% increased odds of surgical site infection among patients reporting a penicillin allergy entirely attributable to the use of a beta-lactam alternative antibiotic (primarily clindamycin or vancomycin). This study provides a review of the prevalence of PAL, the cross-reactivity with cefazolin, immunogenic components of cefazolin and penicillin, and current guidelines for preoperative antibiotic selection in patients with PALs. On understanding these principles, a new set of guidelines and a risk stratification tool are proposed for assessing allergies and determining appropriate antibiotic choice, dosage, and timing in the orthopaedic preoperative setting.
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