Signs of anaphylaxis (wheezing, swelling, hypotension) require stopping the drug and immediate intervention.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A client reports a penicillin allergy. The provider orders a cephalosporin. The nurse should:
Answer: B. There is a small cross-reactivity between penicillins and cephalosporins; verify the type/severity of the penicillin reaction and clarify with the provider before giving — especially if the prior reaction was anaphylaxis.
Question 2 of 2
A client is to receive the first dose of IV ceftriaxone. Before administering, which information in the client's history is most important for the nurse to assess?
Answer: A. Cephalosporins share a beta-lactam ring with penicillins, so a penicillin allergy raises concern for cross-sensitivity; a history of severe penicillin reaction (anaphylaxis) is the priority to assess. A history of seasonal allergies, lactose intolerance, or a family history of diabetes does not contraindicate the drug.
Keep the streak going with more questions like these, each with a full rationale.
What is cephalosporins?
They are widely used for surgical prophylaxis, pneumonia, UTIs, and meningitis. The key safety concern is allergy cross-reactivity with penicillins and a disulfiram-like reaction with alcohol for certain agents.
Key points to remember
- Cephalosporins are bactericidal and inhibit bacterial cell wall synthesis like penicillins.
- There is partial cross-sensitivity with penicillins, so assess penicillin allergy history carefully.
- Higher generations generally have broader gram-negative and CNS penetration.
- Some cephalosporins cause a disulfiram-like reaction (flushing, nausea, vomiting) when combined with alcohol.
- Ceftriaxone must not be mixed or co-infused with calcium-containing IV fluids, especially in neonates.
- Cephalosporins can prolong bleeding time and increase the effect of anticoagulants.
Nursing priorities
- Screen for penicillin and cephalosporin allergy and document the reaction type before giving.
- Avoid mixing ceftriaxone with calcium-containing solutions and flush lines between them.
- Monitor for bleeding and check PT/INR in patients also taking anticoagulants.
- Watch for and report signs of superinfection such as thrush or new diarrhea.
- Give over the prescribed time and observe for allergic reaction after the dose.
Labs & values
Patient teaching
- Avoid all alcohol during therapy and for several days after if told the drug interacts with alcohol.
- Complete the full course of medication as prescribed.
- Report rash, hives, swelling, or breathing difficulty immediately.
- Report severe diarrhea rather than treating it with over-the-counter antidiarrheals.
Red flags: report now
- Signs of anaphylaxis (wheezing, swelling, hypotension) require stopping the drug and immediate intervention.
- Severe watery or bloody diarrhea may be C. difficile colitis and must be reported.
- Never co-administer ceftriaxone with calcium IV products in neonates due to fatal precipitates.
References
Clinical references for this topic
