Abstract
About 10% of U.K. patients believe that they are allergic to penicillin and have a “penicillin allergy label” in their primary care health record. However, around 90% of these patients may be mislabelled. Removing incorrect penicillin allergy labels can help to reduce unnecessary broad-spectrum antibiotic use. A rapid review was undertaken of papers exploring patient and/or clinician views and experiences of penicillin allergy testing (PAT) services and the influences on antibiotic prescribing behaviour in the context of penicillin allergy. We reviewed English-language publications published up to November 2017. Limited evidence on patients’ experiences of PAT highlighted advantages to testing as well as a number of concerns. Clinicians reported uncertainty about referral criteria for PAT. Following PAT and a negative result, a number of clinicians and patients remained reluctant to prescribe and consume penicillins. This appeared to reflect a lack of confidence in the test result and fear of subsequent reactions to penicillins. The findings suggest lack of awareness and knowledge of PAT services by both clinicians and patients. In order to ensure correct penicillin allergy diagnosis, clinicians and patients need to be supported to use PAT services and equipped with the skills to use penicillins appropriately following a negative allergy test result.
Highlights
Prescribing the most appropriate antibiotic class, the narrowest effective spectrum, duration, and dose will help to improve patient outcomes whilst reducing development of antibiotic resistance.Allergies to antibiotics influence prescribing decisions, sometimes preventing treatment with “first-line” antibiotics.Penicillins are generally safe, effective, and narrow-spectrum and, as a result, are the first-line recommended treatment for many infections
Antibiotics 2018, 7, 71 that they are allergic to penicillin and have a “penicillin allergy label” in primary care electronic health records [1]
We searched for studies that described either (a) patient or clinician views and experiences of penicillin allergy or testing for penicillin allergy or (b) influences on clinicians’ antibiotic prescribing behaviour in the context of penicillin allergy
Summary
Prescribing the most appropriate antibiotic class, the narrowest effective spectrum, duration, and dose will help to improve patient outcomes whilst reducing development of antibiotic resistance.Allergies to antibiotics influence prescribing decisions, sometimes preventing treatment with “first-line” antibiotics.Penicillins are generally safe, effective, and narrow-spectrum and, as a result, are the first-line recommended treatment for many infections. Antibiotics 2018, 7, 71 that they are allergic to penicillin and have a “penicillin allergy label” in primary care electronic health records [1]. Case series exploring the basis for these allergy labels reveal that only 10% of these people are likely to be truly allergic to penicillins [2]. As a result, these patients are usually prescribed alternative broad-spectrum antibiotics unnecessarily, which contributes to increased antimicrobial resistance. Patients who are mislabeled with an allergy to penicillin can be readily identified using a combination of medical history, skin testing, and oral challenge [4]; this approach offers greater specificity than each element alone [5]. The combination of negative skin testing and negative oral challenge testing has been found to have >99% negative predictive value for penicillin allergy [6]
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