Antibiotic Allergy Labels in Children Are Associated With Adverse Clinical Outcomes

Abstract

To examine whether antibiotic allergy labeling has a significant impact on clinical outcomes in children.The study included 1672 pediatric patients. The mean age of patients was 6.8 years (range: 0–18.7 years).Children with an antibiotic allergy label in their charts admitted to a tertiary care teaching hospital in Australia were retrospectively identified from April 2014 to April 2015 through chart review. Data collected included history of allergic reaction, antibiotic allergy label, diagnosis on admission, antibiotics prescribed, admitting specialty, length of stay, and hospital readmissions within 4 weeks and 6 months of discharge.Antibiotic allergies were recorded in 5.3% of the cohort, with β-lactams most commonly reported (85%). Increasing age was significantly associated with increased likelihood of having a documented allergy label, most commonly a β-lactam allergy label. Children with antibiotic allergy labels were more likely to receive macrolides, quinolones, lincosamides, and nitroimidazoles compared with patients without an allergy label. After adjusting for age, sex, diagnosis, and admitting specialty, an antibiotic allergy label was associated with prolonged length of hospital stay (odds ratio: 1.62; 95% confidence interval: 1.05–2.50).Researchers in this study found that antibiotic allergy labeling was associated with negative clinical outcomes in children, including longer hospital stays and greater use of broad-spectrum antibiotics when compared with patients without an antibiotic allergy label.This is the first study to examine the effect of antibiotic allergy labels on clinical outcomes in children. In addition to increased hospital stays, this study demonstrated increased use of reserve antibiotics. More liberal use of broad-spectrum antimicrobial agents is concerning because these medications can increase risk of multidrug resistance. Patients with mild to moderate reactions could potentially undergo allergy evaluation and be delabeled. Researchers in this study suggest that early delabeling may aid in mitigating adverse clinical outcomes in children with antibiotic allergy labels.