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First- and second-generation cephalosporins are the prophylactic agents of choice for patients undergoing total joint arthroplasty, but cefazolin often is withheld in patients with reported penicillin allergy. This occurs despite the fact that fewer than 5% of patients whose records indicate penicillin allergy are truly allergic to penicillin and despite the lack of cross-reactivity between cefazolin and penicillin. (In addition, cefazolin has no cross reactivity with any cephalosporin available in the U.S.)
A large U.S. orthopedic group implemented a questionnaire-based protocol to risk-stratify 357 patients labeled as penicillin allergic; patients were categorized as intolerant (e.g., mild gastrointestinal symptoms, headache), low risk (e.…