The 2021 Dutch Working Party on Antibiotic Policy (SWAB) guidelines for empirical antibacterial therapy of sepsis in adults

Table 3 Empirical antibacterial therapy of sepsis in patients with a penicillin allergy label

Available allergy label data for penicillins (e.g., amoxicillin, amoxicillin-clavulanic acid, flucloxacillin, penicillin G)	Administration of a penicillin during sepsis	Administration of a cephalosporin or carbapenem during sepsis
Immediate type or delayed type^a reaction very unlikely	Yes	Yes
Possible immediate type reaction occurred > 10 years ago AND symptoms were mild to moderate	No^b	Yes
Possible immediate type reaction occurred < 10 years ago AND/OR reaction was severe (i.e., anaphylactic shock, airway oedema etc.)	No^b	Yes^c
Allergy testing previously confirmed immediate type penicillin allergy	No	Yes^c
Information about the allergy label is not available	No^b	Yes

^aIn case of delayed type reactions e.g., Stevens-Johnson syndrome (SJS), toxic epidermic necrolysis (TEN), tubulointerstitial nephritis (TIN), on a beta-lactam antibiotic, avoid the respective penicillin and choose alternative treatment or consult expert; ^bAfter the patient has recovered from sepsis, skin testing and/or controlled challenge with a beta-lactam may be considered to confirm or rule out allergy to beta-lactams; ^cRisk of a severe immediate type cross allergic reaction is still estimated to be < 1%; Exposure may be avoided until skin-tests or controlled challenge is possible

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