![]() Multiple studies have described that persons with reported penicillin or another ß-lactam antibiotic allergy have higher rates of surgical-site infections, methicillin-resistant Staphylococcus aureus infections, and higher medical care usage ( 653, 662– 664). Moreover, penicillin allergy labels lead to the use of more expensive and less effective drugs and can result in adverse consequences, including longer length of hospital stay and increased risk for infection. The presence of a penicillin allergy label considerably reduces prescribing options for affected patients. Patients often are incorrectly labeled as allergic to penicillin and are therefore denied the benefit of a ß-lactam therapy. The prevalence of reported penicillin allergy in low-income countries is unknown however, limited data indicate that penicillin is one of the most frequently reported antibiotic allergies ( 661). Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication ( 660). One large study in an STI clinic revealed that 8.3% of patients reported penicillin or another ß-lactam antibiotic allergy ( 659). population and higher among hospital inpatients and residents in health care–related facilities ( 655– 658). Prevalence of reported allergy to penicillin is approximately 10% among the U.S. For patients with a diagnosis of gonorrhea and a concomitant reported allergy to penicillin, ceftriaxone is often avoided, even though the cross-reactivity between penicillin allergy and third-generation cephalosporins is low ( 652– 654). pallidum chromosomal mutations associated with azithromycin and other macrolide resistance and documented treatment failures in multiple geographic areas, azithromycin should not be used as treatment for syphilis ( 23,606–608). For extragenital site infections, especially pharyngeal, failure rates of nonceftriaxone regimens can be substantial. Ceftriaxone, a third-generation cephalosporin, is recommended for gonorrhea treatment. ![]() Penicillin is recommended for all clinical stages of syphilis, and no proven alternatives exist for treating neurosyphilis, congenital syphilis, or syphilis during pregnancy. ![]() Penicillin and other ß-lactam antibiotics have a crucial role in treating STIs.
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