Intracameral Cefuroxime Use in Cataract Surgery After Penicillin Allergy Reclassification
Abstract
IMPORTANCE: Among patients who have a penicillin allergy label (a history of any reaction to penicillin in their medical records), many cataract surgeries are performed yearly. Less than 1% of these patients have a true allergy to penicillin. The evidence supports limited concern regarding cephalosporin cross-reactivity; however, the guidance for surgeons regarding antibiotic selection in these patients remains unclear.
OBJECTIVE: To examine rates of perioperative antibiotic selection after penicillin allergy label reclassification vs before reclassification.
DESIGN, SETTING, AND PARTICIPANTS: Quality improvement study including 1905 patients identified with a penicillin allergy label undergoing cataract surgery between May 30, 2020, and May 30, 2025, at a large tertiary eye care center in the US. This analysis was conducted from June 2025 to December 2025.
INTERVENTION: Policy intervention for surgeons performing cataract surgery that featured enhanced pharmacy collaboration and guidance, suppression of automated electronic medical record alerts for cephalosporin cross-reactivity, and reclassification of the allergy in the medical record. The policy intervention date was set as November 30, 2022.
MAIN OUTCOMES AND MEASURES: Patient receipt of intracameral antibiotics (1.0 mg/0.1 mL of cefuroxime or 0.5 mg/0.1 mL of moxifloxacin), topical antibiotics (eg, erythromycin or moxifloxacin), or no prophylaxis. Perioperative antibiotic selection rates were measured for all patients…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,905 participants or records.
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