{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T17:12:25Z","timestamp":1786381945250,"version":"build-2736575974"},"reference-count":12,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X25000091_as1\"><jats:title>Background:<\/jats:title><jats:p>Concerns about penicillin-cephalosporin cross-reactivity have historically led to conservative prescribing and avoidance of cephalosporins in patients with penicillin allergy labels, potentially causing suboptimal outcomes. Recent evidence suggests a lower risk of cross-reactivity, prompting a reassessment of alert systems.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000091_as2\"><jats:title>Objective:<\/jats:title><jats:p>To assess the impact of limited penicillin cross-reactivity alerts on outpatient cephalosporin use and the incidence of adverse reactions in a healthcare setting.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000091_as3\"><jats:title>Methods:<\/jats:title><jats:p>This retrospective cohort study compared cephalosporin prescribing and adverse reactions in patients labeled as penicillin-allergic before and after limiting penicillin cross-reactivity alerts in the electronic medical record at a large academic medical center.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000091_as4\"><jats:title>Results:<\/jats:title><jats:p>Among 17,174 patients (8,131 pre- and 9,043 post-implementation), there was a statistically significant increase in outpatient cephalosporin prescribing by 8% (<jats:italic>P<\/jats:italic> &lt; .001). The use of alternative antibiotic classes decreased. There was no statistically significant increase in adverse events pre- and post-implementation (0.036%\u20130.058%, <jats:italic>P<\/jats:italic> = .547), and no severe events were attributable to cross-reactivity. The alert modification reduced alerts by 92% (<jats:italic>P<\/jats:italic> &lt; .001).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000091_as5\"><jats:title>Conclusion:<\/jats:title><jats:p>The reduction of penicillin-cephalosporin cross-reactivity alerts was associated with increased cephalosporin use, without a significant increase in adverse reactions. This demonstrates that the practice is safe and decreases alert burden.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2025.9","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T09:24:28Z","timestamp":1741857868000},"page":"416-421","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":5,"title":["Assessing the safety of increased outpatient cephalosporin use following the modification of penicillin allergy cross-reactivity alerts"],"prefix":"10.1017","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4049-7117","authenticated-orcid":false,"given":"Bryan","family":"Schneider","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7988-320X","authenticated-orcid":false,"given":"Kelly M.","family":"Percival","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M.","family":"Rhinehart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Frye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deanna L.","family":"McDanel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin L.","family":"Bebout","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5833-7413","authenticated-orcid":false,"given":"Lukasz D.","family":"Weiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Auerbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy M.","family":"Dowden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5446-3789","authenticated-orcid":false,"given":"Dilek","family":"Ince","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2600-1784","authenticated-orcid":false,"given":"Patrick","family":"Kinn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"S0899823X25000091_ref11","unstructured":"11. 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