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/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-101221-en.cckm

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IP - Beta-Lactam Graded Challenge - Adult - Supplemental [5987]

IP - Beta-Lactam Graded Challenge - Adult - Supplemental [5987] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Beta-Lactam Graded Challenge - Adult - Supplemental [5987]
INTENDED FOR ADULT PATIENTS ONLY
This order set is not comprehensive and if the prescriber does not find their intended drug, they should contact the
Antimicrobial Stewardship Pharmacist (Pager 4321).
Patients should have beta blockers held for 1-2 doses prior to the graded challenge, if possible, to prevent resistance to
treatment if a severe adverse reaction occurs.
Do not pretreat patients with glucocorticoids or antihistamines as these can mask the signs of allergic reactions.
Patients must be able to report symptoms and use call light. Patients do not need to increase their level of care during the
graded challenge.
Treatment of Patients with Reported Allergies to Beta-
Lactam Antibiotics – Adult – Inpatient – Clinical Practice
Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/infection-and-isolation/name-97535-
en.cckm
Patient Care Orders
Non-Categorized Patient Care Orders [203653]
Beta-Lactam Graded Challenge Monitoring
[NURCOM0022]
ONCE For 1 Occurrences, Starting with initial dose through
60 minutes after completion of final dose:
Instruct patient to notify staff of any symptoms. Example
symptoms of a reaction include hives, clearing of throat,
coughing, dyspnea, abdominal pain, or uneasiness. If
symptoms occur, stop the challenge and notify provider.
Patients must be able to report symptoms and use call light.
Patients do not need to increase their level of care during the
graded challenge.
Contingency Parameters [203655]
Notify [NURCOM0001] Provider to Notify: Provider
Notify based on: Other
Other: For Beta-Lactam Graded Challenge: Notify provider
prior to initiating the graded challenge. Notify for any sign of
an allergic reaction (examples: hives, clearing of throat,
coughing, dyspnea, abdominal pain, uneasiness).
For 60 minutes after the full dose is administered.
Notify [NURCOM0001] Provider to Notify: Other (Comment)
Notify based on: Other
Other: For Beta-Lactam Graded Challenge: Contact
pharmacist to update the patient's allergy information if a
reaction occurs or 60 minutes after the full dose is
administered if no reaction occurs.
Medications
Intravenous Medications [200962]
Ampicillin [200964] "Followed by" Linked Panel
ampicillin (OMNIPEN) intraVENOUS [800009] 20 mg, Intravenous, ONCE For 1 Doses
ampicillin (OMNIPEN) intraVENOUS [800009] 200 mg, Intravenous, ONCE Starting H+60 Minutes For 1
Doses
ampicillin (OMNIPEN) intraVENOUS [800009] 2 g, Intravenous, ONCE Starting H+120 Minutes For 1
Doses
Penicillin G SODIUM [200965] "Followed by" Linked Panel
penicillin G SODIUM intraVENOUS [800069] 0.02 Million Units, Intravenous, ONCE For 1 Doses
penicillin G SODIUM intraVENOUS [800069] 0.2 Million Units, Intravenous, ONCE Starting H+60
Minutes For 1 Doses
penicillin G SODIUM intraVENOUS [800069] 2 Million Units, Intravenous, ONCE Starting H+120 Minutes
For 1 Doses
Oxacillin [200966] "Followed by" Linked Panel
oxacillin intraVENOUS [800065] 20 mg, Intravenous, ONCE For 1 Doses
oxacillin intraVENOUS [800065] 200 mg, Intravenous, ONCE Starting H+60 Minutes For 1
Doses
oxacillin intraVENOUS [800065] 2 g, Intravenous, ONCE Starting H+120 Minutes For 1
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Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org

Doses
Cefazolin [200967] "Followed by" Linked Panel
cefazolin (ANCEF) intraVENOUS [800000] 10 mg, Intravenous, ONCE For 1 Doses
cefazolin (ANCEF) intraVENOUS [800000] 100 mg, Intravenous, ONCE Starting H+60 Minutes For 1
Doses
cefazolin (ANCEF) intraVENOUS [800000] 1,000 mg, Intravenous, ONCE Starting H+120 Minutes For
1 Doses
Cefuroxime - NOTE: This drug is a surrogate for
cefoxitin [200969]
"Followed by" Linked Panel
cefuroxime (ZINACEF) intraVENOUS [800030] 15 mg, Intravenous, ONCE For 1 Doses
cefuroxime (ZINACEF) intraVENOUS [800030] 150 mg, Intravenous
cefuroxime (ZINACEF) intraVENOUS [800030] 1.5 g, Intravenous, ONCE Starting H+120 Minutes For 1
Doses
Ceftriaxone [200970] "Followed by" Linked Panel
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 10 mg, Intravenous, ONCE For 1 Doses
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 100 mg, Intravenous, ONCE Starting H+60 Minutes For 1
Doses
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1,000 mg, Intravenous, ONCE Starting H+120 Minutes For
1 Doses
Cefepime - NOTE: This drug is a surrogate for
ceftaroline [200971]
"Followed by" Linked Panel
cefepime (MAXIPIME) intraVENOUS [800016] 10 mg, Intravenous, ONCE For 1 Doses
cefepime (MAXIPIME) intraVENOUS [800016] 100 mg, Intravenous, ONCE Starting H+60 Minutes For 1
Doses
cefepime (MAXIPIME) intraVENOUS [800016] 1,000 mg, Intravenous, ONCE Starting H+120 Minutes For
1 Doses
Meropenem - This drug is a default for all carbapenems
[200974]
"Followed by" Linked Panel
meropenem (MERREM) intraVENOUS [800055] 5 mg, Intravenous, ONCE Starting H For 1 Doses
meropenem (MERREM) intraVENOUS [800055] 50 mg, Intravenous, ONCE Starting H+60 Minutes For 1
Doses
meropenem (MERREM) intraVENOUS [800055] 500 mg, Intravenous, ONCE Starting H+120 Minutes For 1
Doses
Oral Medications [200963]
Use penicillin if you are considering therapy with any oral penicillin including dicloxacillin
Use amoxicillin if you are considering therapy with amoxicillin, amoxicillin/clavulanate, ampicillin, cefaclor, cefadroxil,
cefprozil and cephalexin
Use cefpodixime if you are considering therapy with cefpodoxime and cefditoren
Penicillin V potassium [200981] "Followed by" Linked Panel
penicillin V potassium (VEETID) 250 MG/5ML soln
[40830]
50 mg, Oral, ONCE For 1 Doses
penicillin V potassium (VEETID) 250 MG/5ML soln
[40830]
500 mg, Oral, ONCE Starting H+60 Minutes For 1 Doses
Amoxicillin [200982] "Followed by" Linked Panel
amoxicillin (AMOXIL) 250 MG/5ML susp [34527] 50 mg, Oral, ONCE For 1 Doses
amoxicillin (AMOXIL) 250 MG/5ML susp [34527] 500 mg, Oral, ONCE Starting H+60 Minutes For 1 Doses
Cefpodoxime [200984] "Followed by" Linked Panel
cefpodoxime (VANTIN) 100 MG/5ML susp [44560] 40 mg, Oral, ONCE For 1 Doses
cefpodoxime (VANTIN) 100 MG/5ML susp [44560] 400 mg, Oral, ONCE Starting H+60 Minutes For 1 Doses
Adverse Reaction Treatment [201629]
diphenhydramine (BENADRYL) injection [800106] 25-50 mg, Intravenous, EVERY 6 HOURS PRN For 2 Doses,
For allergic reaction to beta-lactam antibiotic. Signs of an
allergic reaction may include hives, clearing of throat,
coughing, dyspnea, abdominal pain, or uneasiness. May
repeat dose after 6 hours if needed. Contact provider if given.
epINEPHrine (ANAPHYLAXIS) injection [800185] 0.3 mg, Intramuscular, EVERY 6 HOURS PRN For 2 Doses,
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Printed by LIND, JANNA S [JSL237] at 6/22/2016 8:27:57 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org

For allergic reaction to beta-lactam antibiotic. Signs of an
allergic reaction may include hives, clearing of throat,
coughing, dyspnea, abdominal pain, or uneasiness. May
repeat dose after 6 hours if needed. Contact provider if given.
albuterol neb soln (3 mL) [800248] 2.5 mg, Nebulization, EVERY 6 HOURS PRN For 2 Doses,
dyspnea
May repeat dose after 6 hours if needed. Notify provider if
given.
Non-categorized [205523]
Patients should have beta blockers held for 1-2 doses prior to the graded challenge, if possible, to prevent resistance to
treatment if a severe adverse reaction occurs.
Note: Hold Medication Communication [950057] ONCE For 1 Doses
Page 3 of 3
Printed by LIND, JANNA S [JSL237] at 6/22/2016 8:27:57 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org