Doctor prescribes Ceflax to patient with penicillin allergy; what, if anything, should be done?

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Jonathan Kamens - 28 Jan 2004 05:13 GMT

I'm looking for advice from qualified medical professionals about the
following scenario.

I had emergency surgery recently. The surgeon was the chief of surgery
at the hospital to which I had been admitted; I had no prior
relationship with him.

Yesterday, I had a scheduled appointment at his office for the removal
of the staples in my incision. Upon inspection of the incision site,
he remarked that it seemed red and tender enough to indicate a possible
infection and prescribed an antibiotic, Ceflax, as a first step (i.e.,
if the redness and tenderness subsides, then either there was actually
on infection or the Ceflax knocked it down, but if it doesn't, then
further treatment will be necessary).

Shortly after I dropped off the prescription at my pharmacy, they
called me and asked me to have the doctor call them to confirm the
prescription, because I am allergic to penicillin and Ceflax is
related to penicillin.

I called the doctor and reminded him of my penicillin allergy. He
remarked, "Oh, I didn't know that," confirmed that he should not have
prescribed me Ceflax, called the pharmacy and had them change the
prescription to Cipro.

My penicillin allergy was recorded in my hospital records, on a steel
MedicAlert bracelet which I wear all the time, on an allergy bracelet
issued by the hospital which I wore for my entire stay, and on the
new-patient form I filled out at the doctor's office.

My questions are:

1) How dangerous could it have been for me to take the Ceflax? The
penicillin allergy was diagnosed after a reaction in childhood over
twenty years ago and I've taken no cillin antibiotics since then.

2) Was the doctor's error in prescribing Ceflax to me serious enough
that I should bring it to someone's attention, e.g., the hospital
where I had the surgery, the state medical board, etc.?

3) If I do report the error, is it likely that anything will actually
come of it? I don't want to waste my time if it's just going to be
ignored. It may be relevant that I live in Massachusetts.

Thanks in advance for any advice you can provide.

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taurusrc@aol.com - 28 Jan 2004 07:09 GMT

I had an anaphylactic reaction to penicillin and ended up in the Emergency
ward. The doctor in charge had much difficulty accepting the fact that it was
an allergic reaction and he spent several hours trying to find something else
wrong with me. He wanted me to stay overnight so they could "do more tests" but
didn't have any plan as to what tests. I refused to stay and finally he ordered
a urinalysis and found an infection. He was about to give me an injection of
penicillin when I stopped him and reminded him that I was there because I had a
reaction to penicillin.

Ora

>I'm looking for advice from qualified medical professionals about the
>following scenario.
[quoted text clipped - 41 lines]
>
>Thanks in advance for any advice you can provide.

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anon - 29 Jan 2004 00:16 GMT

> I'm looking for advice from qualified medical professionals about the
> following scenario.

I'm an M.D., board-certified in family medicine (I hope that's qualified).

> 1) How dangerous could it have been for me to take the Ceflax? The
> penicillin allergy was diagnosed after a reaction in childhood over
> twenty years ago and I've taken no cillin antibiotics since then.

That depends on the severity of the reaction that you had as a child. If
the reaction was a rash or stomach upset, the risk of taking Keflex (the
correct spelling) was likely quite small. If the reaction was anaphylaxis
(a near-fatal allergic reaction), the risk could be significant, if you
happen to be one of the unlucky minority of patients who cross-react to
both penicillins and cephalosporins (Keflex and its relatives). More on
that below.

> 2) Was the doctor's error in prescribing Ceflax to me serious enough
> that I should bring it to someone's attention, e.g., the hospital
> where I had the surgery, the state medical board, etc.?

No, certainly not. He didn't do anything that was explicitly
contraindicated. The rate of cross-sensitivity in patients with known
penicillin allergy is poorly defined. Studies suggest that 5.4-16.5% of
patients with a history of penicillin hypersensitivity also demonstrated
allergies to cephalosporins (drugs in the same family as Keflex). If a
patient has a history of IgE-mediated hypersensitivity (anaphylaxis,
urticaria, angioedema) to penicillin, it's prudent to avoid the use of
cephalosporins. Lacking that history, many physicians will prescribe
cepalosporins to patients with mild or ill-defined penicillin "allergies"
which may not be IgE-mediated, since the vast majority of them will have no
problem taking them, and they are excellent agents for skin infections,
such as you had.

Hope this helps.

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