In the overall group of 611 children with UTI, trimethoprim-sulfamethoxazole was prescribed for 61%, amoxicillin for 29%, nitrofurantoin for 7%, and other antimicrobials including first-generation cephalosporins
for the other 3%.
According to the recent IDSA guidelines, erythromycin is identified as a suitable alternative for patients allergic to penicillin; first-generation cephalosporins are also recommended, providing the patient does not have immediate-type hypersensitivity to [beta]-lactam antibiotics.
(38,40) However, the early first-generation cephalosporins included in this analysis were produced by the Cephalosporium mold and actually contained trace amounts of penicillin.
The increased risk of allergic reactions in penicillin-allergic patients is only 0.4% for first-generation cephalosporins
and "nearly nil" for certain later-generation agents, which he defined as cefdinir, cef-podoxime, and cefuroxime.
When the first-generation cephalosporins
cephaloridine and cephalothin were introduced in the 1960s, allergic and anaphylactic reactions were reported in patients with previous allergic reactions to penicillins.
For example, first-generation cephalosporins
have activity against most strains of MSSA but nearly all MRSA isolates are resistant.
When the 1978 paper was published, only first-generation cephalosporins