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Table 8.2 Cross-reacting side chains between ß-lactam antibiotics

  Amoxicillin Ampicillin Cefaclor Cefadroxil Cefepime Cefoperazone Cefotaxime Cefoxitin Cefpodoxime Ceftazidime Ceftibuten Ceftriaxone Cefuroxime Cephalexin Cephaloridine Cephalothin Cephradine Penicillin G
Amoxicillin   6 6/7 6/7                   6/7     6/7  
Ampicillin 6   6/7 6/7                   6/7     6/7  
Cefaclor 6/7 6/7   7                   7     7  
Cefadroxil 6/7 6/7 7                     3,7     3,7  
Cefepime             7   7     7            
Cefoperazone                                    
Cefotaxime         7       7     7       3    
Cefoxitin                         3   7 7   6/7
Cefpodoxime         7   7         7            
Ceftazidime                                    
Ceftibuten                                    
Ceftriaxone         7   7   7                  
Cefuroxime               3                    
Cephalexin 6/7 6/7 7 3,7                         3,7  
Cephaloridine               7               7   6/7
Cephalothin             3 7             7     6/7
Cephradine 6/7 6/7 7 3,7                   3,7        
Penicillin G               6/7             6/7 6/7    

 

Numbers denote position of side chains: 3, similarity at the cephalosporin 3—position side chain; 7, similarity at the cephalosporin 7—position side chain; 6/7, similarity at the penicillin 6—position side chain and the cephalosporin 7—position side chain.
Each number in the matrix indicates side-chain similarity between two drugs. Cross-allergenicity is expected between each similar pair. For example, a patient allergic to amoxicillin would very likely manifest an allergic reaction to ampicillin, cefadroxil, cefaclor, cephalexin and cephradine. However, the patient would not be expected to exhibit an allergic response to cefepime, cefoperazone, cefotaxime, etc., unless he/she was also allergic to another cephalosporin or penicillin with a similar side chain to the reference drug.
Reference: (514)