Penicillin relabeling boosts intracameral cefuroxime use

A June 2 report in Ophthalmology Advisor highlighted a cataract-surgery quality improvement study showing that revising penicillin allergy labels changed which antibiotics surgeons used in the operating room. The underlying study, published in JAMA Ophthalmology, examined 3,077 cataract surgeries in 1,905 patients with penicillin allergy labels at a large U.S. tertiary eye center. Researchers found that intracameral cefuroxime use increased markedly after a policy intervention that combined allergy-label reclassification, pharmacy guidance and suppression of automated electronic medical record alerts for cephalosporin cross-reactivity. ### Why were penicillin allergy labels affecting cataract surgery antibiotics? JAMA Ophthalmology said patients with penicillin allergy labels often trigger caution around cephalosporins, even though “less than 1%” have a true penicillin allergy and evidence supports limited concern about cephalosporin cross-reactivity. In cataract surgery, that matters because surgeons may avoid cefuroxime and choose alternatives when a penicillin allergy appears in the medical record. (jamanetwork.com) Ophthalmology Advisor said the policy change removed unnecessary penicillin allergy labels and allowed surgeons to use intracameral cefuroxime more routinely for endophthalmitis prevention in cataract operations. The outlet’s report was based on the JAMA Ophthalmology study. ### What exactly changed at the eye center? The intervention date was November 30, 2022, according to JAMA Ophthalmology. (jamanetwork.com) After that date, surgeons received enhanced pharmacy collaboration and guidance, automated electronic medical record alerts about cephalosporin cross-reactivity were suppressed, and penicillin allergy labels were reclassified in the record. The study covered surgeries performed between May 30, 2020, and May 30, 2025, at the University of Michigan’s Kellogg Eye Center in Ann Arbor, based on the author affiliations listed by JAMA Ophthalmology. Karthik Reddy, Paul Workman, Greg Eschenauer, Jill Bixler and Shahzad I. Mian were among the authors. ### How large was the change in cefuroxime use? JAMA Ophthalmology reported that mean intracameral cefuroxime use increased after the policy intervention date compared with before it, by 71% versus 2%, respectively. (jamanetwork.com) The surgeries were performed by 51 surgeons, giving the study a broad view of practice patterns inside one center. The antibiotic options tracked in the study included intracameral cefuroxime at 1.0 mg/0.1 mL, intracameral moxifloxacin at 0.5 mg/0.1 mL, topical antibiotics such as erythromycin or moxifloxacin, or no prophylaxis. (jamanetwork.com) Researchers measured perioperative antibiotic selection rates across all cataract surgeries in patients carrying penicillin allergy labels. ### Did the report say the change was safe? (jamanetwork.com) Ophthalmology Advisor characterized the increase in cefuroxime use after penicillin allergy relabeling as safe. JAMA Ophthalmology’s abstract, as surfaced in search results, said the intervention supported “more appropriate and consistent antibiotic use” in patients with penicillin allergy labels undergoing cataract surgery. (jamanetwork.com) PubMed records cited in broader literature also describe intracameral cefuroxime as appearing safe in cataract populations, while noting that true cefuroxime allergy is rare and documented reactions can occur. Those reports provide context for why centers may focus on distinguishing true drug allergy from precautionary labeling. ### What is the practical takeaway from the study? (jamanetwork.com) The JAMA Ophthalmology study was framed as a quality improvement effort rather than a drug-comparison trial. Its focus was operational: how allergy documentation, pharmacy involvement and electronic record design changed antibiotic selection by surgeons. The paper’s study window ended on May 30, 2025, and the analysis was conducted from June 2025 to December 2025, JAMA Ophthalmology said. (pubmed.ncbi.nlm.nih.gov) Ophthalmology Advisor published its summary on June 2, 2026, pointing readers to the cataract-surgery prophylaxis findings and the implementation steps described in the study. (jamanetwork.com)