Perioperative Penicillin and Cephalosporin May Be Appropriate for Patients Labeled as Allergic

De Luca JF, Vogrin S, Holmes NE, et al. Perioperative Penicillin and Cephalosporin Antibiotic Allergy Assessment and Testing: The PREPARE Pilot Randomized Clinical Trial. JAMA Surg. 2025; in press.

Available evidence has shown that patients identified as being allergic to penicillin and cephalosporin antimicrobials are at increased risk for perioperative mortality and infection. The need to use broad spectrum intravenous antimicrobials for preoperative prophylaxis in these patients contributes to the rising rate of antimicrobial resistance.

Other data cited in this article confirmed that more than 90% of patients labelled as allergic were able to take penicillin and cephalosporin antimicrobials without an allergic reaction.

This randomized trial (n = 150), conducted in three Australian hospitals, included patients who were labelled as allergic and were randomized to receive enhanced antimicrobial preoperative allergy assessment including oral challenge or skin testing or no intervention. Patients at low risk received preoperative antimicrobials.

Mild antimicrobial-related adverse events occurred in 5.4% of the intervention group; one of these events was an immune-related skin rash.

The authors concluded that preoperative allergy testing was effective for identifying patients who could have the antimicrobial allergy label removed safely permitting the use of optimal perioperative antimicrobial prophylaxis.