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Figure 1: Chemical structures of benzylpenicillin (A), cefotaxime (B) and amoxicillin (C)

The thiazolidine ring in penicillins, the dihydrothiazine ring in cephalosporins and the side chains in beta-lactam antibiotics are immunogenic. Drug metabolites containing these components act as incomplete antigens that can covalently bind to larger proteins to elicit an immune response in patients.

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