Enhancing antibiotic stewardship by tackling ‘spurious’ penicillin allergy

Abstract

Approximately 90-99% of patients with a label of penicillin allergy (PenA) are not allergic when comprehensively investigated. An inaccurate label of PenA has major public health implications – longer hospital stay, more frequent hospital admissions, greater use of fluoroquinolones, glycopeptides, cephalosporins and other expensive antibiotics resulting in significantly higher costs to the health service and predisposing to Clostridium difficile, meticillin-resistant Staphylococcus aureus infections and vancomycin resistant enterococcus.

We describe lessons learnt from recent studies regarding possible reasons contributing to an inaccurate label of PenA as well as propose a concerted multidisciplinary approach to address this important public health problem. Given the unmet need for allergy services in the UK and several other countries and knowledge gaps regarding PenA amongst health care professionals, we describe the potential role for a computerised clinical decision support system to enable nonspecialists rapidly identify and de-label 'low risk' hospitalised patients with a label of PenA thereby obviating the need for allergy tests. This approach however needs rigorous evaluation for feasibility, safety, patient & physician acceptability, cost effectiveness and its compatibility with information technology systems currently employed in the health service.

This article is protected by copyright. All rights reserved.

http://ift.tt/2yf2Ha6