Desensitization to ceftaroline in a patient with multiple medication hypersensitivity reactions

• Published in: American journal of health-system pharmacy Vol. 72; no. 3; pp. 198 - 202
• Main Authors: JONES, JUSTIN M, RICHTER, LISA M, ALONTO, AUGUSTO, LEEDAHL, DAVID D
• Format: Journal Article
• Language: English
• Published: England Copyright American Society of Health-System Pharmacists, Inc. All rights reserved 01.02.2015; Oxford University Press
• Subjects: Adult; Allergy; Allergy desensitization; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - immunology; Care and treatment; Case studies; Ceftaroline; Cephalosporins - administration & dosage; Cephalosporins - adverse effects; Cephalosporins - immunology; Desensitization, Immunologic - methods; Dosage and administration; Drug Hypersensitivity - immunology; Female; Humans; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Methods; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcus aureus; United States
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp140151

PURPOSEThe case of a patient with multiple medication hypersensitivity reactions and a methicillin-resistant Staphylococcus aureus (MRSA) infection who underwent desensitization to ceftaroline is reported. SUMMARYA 32-year-old Caucasian woman with asthma, gastroesophageal reflux disease, heart murmur, and major depression was admitted for MRSA cellulitis with a subcutaneous abscess along the left sternomanubrial joint and clavicular osteomyelitis secondary to port placement after gastric bypass surgery. The patient had an extensive history of hypersensitivity reactions. Pertinent documented allergies were as followspenicillin (anaphylaxis), daptomycin (anaphylaxis), vancomycin (hives), linezolid (hives), ertapenem (rash), ciprofloxacin (rash), and tigecycline (rash). The patient also reported previous reactions to aztreonam (unknown) and gentamicin (hives). The pharmacy was consulted to develop a desensitization protocol for ceftaroline. The desensitization protocol used three serial dilutions of ceftaroline to make 14 sequential infusions with escalating doses. Intramuscular epinephrine, i.v. diphenhydramine, and i.v. methylprednisolone were ordered as needed for the development of immediate hypersensitivity reactions during or after administration of ceftaroline. The cumulative dose (574.94 mg) was administered intravenously over 225 minutes with no breakthrough symptoms reported during or after the desensitization protocol. Ceftaroline fosamil 600 mg i.v. every 12 hours was continued for six weeks. CONCLUSIONDesensitization to ceftaroline was conducted for a patient with extensive history of hypersensitivity reactions to other drugs, including penicillin-induced anaphylaxis. Desensitization and subsequent treatment with full doses of ceftaroline were accomplished without apparent adverse effects.