Anaphylactic reaction relating to intraocular cefuroxime
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Anaphylactic Reaction Relating to Intraocular Cefuroxime
Introduction to Anaphylactic Reactions and Cefuroxime
Anaphylactic reactions are severe, life-threatening allergic responses that can occur rapidly after exposure to an allergen. Cefuroxime, a second-generation cephalosporin antibiotic, is commonly used for prophylaxis against infections during surgical procedures, including cataract surgery. However, despite its widespread use, there are documented cases of anaphylactic reactions following its administration.
Case Reports of Anaphylactic Reactions During Cataract Surgery
Intracameral Cefuroxime and Anaphylaxis
Several case reports highlight the occurrence of anaphylactic reactions following the intracameral injection of cefuroxime during cataract surgery. In one instance, a patient with a known penicillin allergy developed an anaphylactic reaction minutes after the injection of cefuroxime at the end of an uneventful phacoemulsification and intraocular lens implantation surgery. The reaction was promptly recognized and treated by the surgeon, underscoring the importance of immediate intervention in such scenarios.
Another report describes a severe anaphylactic reaction occurring approximately five minutes after the administration of 1.0 mg of cefuroxime into the anterior chamber post-phacoemulsification and intraocular lens implantation. The patient, also allergic to penicillin, required immediate resuscitation, highlighting the critical need for trained staff to manage such emergencies, especially in settings where routine topical anesthesia is used without an anesthesiologist present.
Cross-Reactivity and Hypersensitivity
The hypersensitivity to cefuroxime can occur even in the absence of known allergies to other beta-lactam antibiotics. A case involving a 60-year-old man demonstrated an anaphylactic reaction immediately after intramuscular administration of sodium cefuroxime. Subsequent tests confirmed good tolerance to other beta-lactams, suggesting that the side-chain structure of cefuroxime plays a significant role in its allergenic potential.
Broader Implications of Cefuroxime-Induced Anaphylaxis
Systemic Reactions and Clinical Vigilance
Anaphylactic reactions to cefuroxime are not limited to ocular administration. A case report detailed a severe systemic anaphylactic reaction following intravenous administration of cefuroxime in a patient undergoing arthroscopy. The patient exhibited multiple symptoms, including chills, rash, severe chest pain, and hypotension, necessitating immediate resuscitation with IV fluids and steroids. This case emphasizes the need for clinicians to exercise caution when administering cefuroxime, regardless of the route, and to be prepared for potential anaphylactic reactions.
Conclusion
Anaphylactic reactions to intraocular cefuroxime, though rare, are serious and potentially fatal. These reactions can occur even in patients without a known allergy to cefuroxime but with a history of penicillin allergy. The documented cases underscore the importance of immediate recognition and treatment of anaphylaxis, as well as the necessity for trained medical personnel to manage such emergencies effectively. Clinicians should remain vigilant and prepared to handle anaphylactic reactions whenever cefuroxime is administered.
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