Penicillin, piperacillin, amoxicillin, cefadroxil, cefprozil ![]() ![]() Similar R1/R2 side chains – low risk of cross-reactivityīut caution if history of life-threatening reaction Patients may experience an independent allergic reaction to a different β-lactam unrelated to cross-reactivity.Carbapenems and aztreonam have sufficiently dissimilar structures from penicillins/cephalosporins and are not expected to cross-react (exception = aztreonam with ceftazidime or cefiderocol).Caution is warranted for agents with similar R1/R2 side chains if history of life-threatening or severe reactions such as Stevens-Johnson Syndrome, toxic epidermal necrolysis, interstitial nephritis, hemolytic anemia.Risk of cross-reactivity between penicillins/cephalosporins and within cephalosporin class is highest with IDENTICAL R1/R2 side chains.The mechanism of cross-reactivity was previously believed to be related to a common β-lactam ring, but new evidence suggests it is instead related to the sharing of identical R-group side chains. Healthcare professionals often overestimate cross-reactivity between Penicillins and Cephalosporins.
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