Inpatient Beta-lactam test-dose Protocol promotes Antimicrobial Stewardship in Patients with History of Penicillin Allergy

Publication date: Available online 20 November 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Keith A. Sacco, Benjamin P. Cochran, Kevin Epps, Mark Parkulo, Alexei Gonzalez-Estrada

Abstract

Background

Penicillin allergy is the most commonly reported drug allergy in hospitalized patients, resulting in increased second-line antibiotic use, nosocomial infections, and healthcare utilization. Given that the vast majority of patients are not truly allergic, a safe strategy that empowers the admitting physician is needed.

Objective

To assess the impact on antibiotic prescribing practices for hospitalized patients with penicillin allergy using a validated intervention.

Methods

An intervention was implemented to educate providers on management of patients with penicillin allergy using a validated risk-stratification algorithm to guide testing and antibiotic use. 30 days of control data using current standard of care was compared with 60 days of post-intervention data measuring documentation of penicillin allergy history and antibiotic selection.

Results

The relative use of cephalosporin and penicillin antibiotics increased by 121.2% (p=0.027) and 256% (p=0.043) respectively without an increase in adverse drug reactions. There was a decrease in the use of broad-spectrum antibiotics; vancomycin 67.2% (p=0.036), quinolones 33.3% (p=0.31), carbapenems 81.9% (p=0.080), and aztreonam 73.8% (p=0.180).

Conclusion

The antibiotic choice in patients admitted to the hospital with a reported penicillin allergy can be improved by better evaluation of the allergy history and the use of a risk stratification guideline.

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