Source:Journal of Allergy and Clinical Immunology
Author(s): Kimberly G. Blumenthal, Paige G. Wickner, Shelley Hurwitz, Nicholas Pricco, Alexandra E. Nee, Karl Laskowski, Erica S. Shenoy, Rochelle P. Walensky
BackgroundReported penicillin allergy rarely reflects penicillin intolerance. Failure to address inpatient penicillin allergies results in more broad-spectrum antibiotic use, treatment failures, and adverse drug events.ObjectiveWe aimed to determine the optimal approach to penicillin allergies among medical inpatients.MethodsWe evaluated internal medicine inpatients reporting penicillin allergy in three periods: (1) standard of care (SOC), (2) penicillin skin testing (ST), and (3) computerized guideline application with decision support (APP). The primary outcome was use of a penicillin or cephalosporin, comparing interventions to SOC using multivariable logistic regression.ResultsThere were 625 patients: SOC 148, ST 278, and APP 199. Of 278 ST patients, 179 (64%) were skin test eligible; 43 (24%) received testing and none were allergic. In the APP period, there were 292 unique website views; 112 users (38%) completed clinical decision support. While ST period patients did not have an increased odds of penicillin or cephalosporin use overall (aOR 1.3 [95% CI 0.8, 2.0]), we observed a significant increased odds of penicillin or cephalosporin use overall in the APP period (aOR 1.8 [95% CI 1.1, 2.9]), and in a per protocol analysis of the skin tested subset (aOR 5.7 [95% CI 2.6, 12.5]).ConclusionsBoth the computerized guideline with decision support and penicillin skin testing − when completed − increased use of penicillin and cephalosporin antibiotics among inpatients reporting penicillin allergy. While the skin tested subset showed an almost 6-fold impact, the computerized guideline significantly increased penicillin or cephalosporin use overall nearly 2-fold and was readily implemented.
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