Penicillin Allergy Research Articles

An overview of penicillin allergies for nurses

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Self-reported allergy to penicillin and clindamycin administration may be risk factors for dental implant failure: A systematic review, meta-analysis and delabeling protocol.

Growing evidence is highlighting the inefficacy of clindamycin as an effective substitute to amoxicillin in patients self-reporting a penicillin allergy. The hypothesis is that implant failure is higher in these patients, when compared to patients receiving penicillin. To test this hypothesis, a systematic review and meta-analysis was undertaken and a protocol for delabeling penicillin allergic patients was presented. A systematic review was undertaken by searching across three different databases, namely PubMed, Scopus and Web of Science. Out of 572 results, four studies were eligible to be included. Fixed-effects meta-analysis showed a higher number of failed implants in patients who were administered clindamycin, because of a self-reported allergy to penicillin. Results showed that these patients are over three times more likely (OR = 3.30, 95% C.I. 2.58-4.22, p-value < .00001) to undergo implant failure with an average cumulative proportion of 11.0% (95% C.I. 3.5-22.0%) versus 3.8% (95% C.I. 1.2-7.7%) of patients not requiring clindamycin and administered amoxicillin. A protocol for penicillin allergy delabeling is proposed. Current evidence is still limited and based on retrospective observational studies, it is difficult to state if penicillin allergy, clindamycin administration or a combination of both is responsible for the current trends and reported findings.

Pharmacist-led multi-faceted intervention in an antimicrobial stewardship programme at a dental university hospital in Japan

Antimicrobials are commonly prescribed in dentistry. However, inappropriate antimicrobial prescriptions are common in this field. Optimizing antimicrobial prescriptions in dentistry requires an effective strategy for modifying prescribing behaviour. To assess the efficacy of pharmacist-led multi-faceted intervention for the proportion of monthly antimicrobial prescriptions in each drug group per 100 oral antimicrobial prescriptions. A before-after trial was performed at a university hospital outpatient dental clinic. A pharmacist-led, multi-faceted intervention, including immediate and direct feedback to the prescribers, an explanation of the rules of antimicrobial prescriptions for patients with penicillin allergy, tutorials for dentistry students, and a review of hospital-approved antimicrobials, was implemented from April 2017 to March 2022. Antimicrobials were classified into eight groups, namely, penicillins, first- and second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones, macrolides, clindamycin, carbapenem, and others. In total, there were 2,643,988 visits to the outpatient dental clinic during the study period. The monthly mean proportion of prescriptions for penicillins increased from 45.6 to 84.1 per 100 oral antimicrobial prescriptions (P<0.001) while that of third-generation cephalosporins decreased from 43.0 to 7.3 (P<0.001) from the pre-intervention to the intervention period. Moreover, the monthly mean proportion of fluoroquinolones, macrolides, and carbapenems decreased from 11.2 to 7.44 (P<0.001). The intervention modified dentists' antimicrobial prescribing behaviours, leading to an immediate increase in the number of monthly prescriptions for penicillins and a simultaneous decrease in the number of monthly prescriptions for third-generation cephalosporins and other broad-spectrum, oral antimicrobials.

The association between penicillin allergy and surgical site infection after orthopedic surgeries: a retrospective cohort study.

Cephalosporins are used as first-line antimicrobial prophylaxis for orthopedics surgeries. However, alternative antibiotics are usually used in the presence of penicillin allergy (PA), which might increase the risk of surgical site infection (SSI). This study aimed to analyze the relationship between SSI after orthopedic surgeries and PA among surgical candidates and related alternative antibiotic use. In this single-center retrospective cohort study, we compared inpatients with and without PA from January 2015 to December 2021. The primary outcome was SSI, and the secondary outcomes were SSI sites and perioperative antibiotic use. Moreover, pathogen characteristics of all SSIs were also compared between the two cohorts. Among the 20,022 inpatient records, 1704 (8.51%) were identified with PA, and a total of 111 (0.55%) SSI incidents were reported. Compared to patients without PA, patients with PA had higher postoperative SSI risk (1.06%, 18/1704 vs. 0.51%, 93/18318), shown both in multivariable regression analysis (odds ratio [OR] 2.11; 95% confidence interval [CI], 1.26-3.50; p= 0.004) and propensity score matching (OR 1.84; 95% CI, 1.05-3.23; p= 0.034). PA was related to elevated deep SSI risk (OR 2.79; 95% CI, 1.47-5.30; p= 0.002) and had no significant impact on superficial SSI (OR 1.39; 95% CI, 0.59-3.29; p= 0.449). The PA group used significantly more alternative antibiotics. Complete mediation effect of alternative antibiotics on SSI among these patients was found in mediation analysis. Pathogen analysis revealed gram-positive cocci as the most common pathogen for SSI in our study cohort, while patients with PA had higher infection rate from gram-positive rods and gram-negative rods than non-PA group. Compared to patients without PA, patients with PA developed more SSI after orthopedic surgeries, especially deep SSI. The elevated infection rate could be secondary to the use of alternative prophylactic antibiotics.

Penicillin de-labelling in vancouver, British Columbia, Canada: comparison of approaches, outcomes and future directions

BackgroundInaccurate penicillin allergy labels lead to inappropriate antibiotic prescriptions and harmful patient consequences. System-wide efforts are needed to remove incorrect penicillin allergy labels, but more health services research is required on how to best deliver these services.MethodsData was extracted from five hospitals in Vancouver, British Columbia, Canada from October 2018-May 2022. The primary outcomes of this study were to outline de-labelling protocol designs, identify the roles of various healthcare professionals in de-labelling protocols and identify rates of de-labelling penicillin allergies and associated adverse events at various institutions. Our secondary outcome was to describe de-labelling rates for special populations, including pediatric, obstetric and immunocompromised subpopulations. To achieve these outcomes, participating institutions provided their de-labelling protocol designs and data on program participants. Protocols were then compared to find common themes and differences. Furthermore, adverse events were reviewed and percentages of patients de-labelled at each institution and in total were calculated.ResultsProtocols demonstrated a high level of variability, including different methods of participant identification, risk-stratification and roles of providers. All protocols used oral and direct oral challenges, heavily involved pharmacists and had physician oversight. Despite the differences, of the 711 patients enrolled in all programs, 697 (98.0%) were de-labelled. There were 9 adverse events (1.3%) with oral challenges with mainly minor symptoms.ConclusionsOur data demonstrates that de-labelling programs effectively and safely remove penicillin allergy labels, including pediatric, obstetric and immunocompromised patients. Consistent with current literature, most patients with a penicillin allergy label are not allergic. De-labelling programs could benefit from increasing clinician engagement by increasing accessibility of resources to providers, including guidance for de-labelling of special populations.

The evaluation of penicillin allergy in dialysis patients.

Journal Article Accepted manuscript The evaluation of penicillin allergy in dialysis patients Get access Simo Sirkeoja, Simo Sirkeoja Department of Internal Medicine, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland Correspondence to: Simo Sirkeoja; E-mail: simo.sirkeoja@pirha.fi Search for other works by this author on: Oxford Academic PubMed Google Scholar Meeri Honkanen, Meeri Honkanen Department of Internal Medicine, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland Search for other works by this author on: Oxford Academic PubMed Google Scholar Reetta Huttunen, Reetta Huttunen Department of Internal Medicine, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland Search for other works by this author on: Oxford Academic PubMed Google Scholar Satu Mäkelä, Satu Mäkelä Department of Internal Medicine, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland Search for other works by this author on: Oxford Academic PubMed Google Scholar Jaana Syrjänen Jaana Syrjänen Department of Internal Medicine, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland Search for other works by this author on: Oxford Academic PubMed Google Scholar Nephrology Dialysis Transplantation, gfad072, https://doi.org/10.1093/ndt/gfad072 Published: 17 April 2023

An interdisciplinary student-led multifaceted intervention addressing overuse of broad-spectrum antibiotics for patients with penicillin allergies

BackgroundThough 15% of hospitalized patients have a documented penicillin (PCN) allergy, fewer than 1% have an IgE-mediated reaction that necessitates avoidance of β-lactam antibiotics.ObjectiveOur interdisciplinary team of medical and nursing students led and executed a two-pronged quality improvement intervention to reduce prescribing of non-β-lactam antibiotics (NBLs) for patients with reported PCN allergies. To the best of our knowledge, this is the first multidisciplinary student-led intervention aimed at educating providers on low-risk penicillin allergy and encouraging best antibiotic prescribing practices.Design and participantsThe intervention took place from June 2021 to February 2022. We developed and provided clinician education modules, including peer-to-peer information sharing and in-person small group discussions, as well as clinical decision support (CDS) strategies through the electronic medical record (EMR). The target population was attendings, residents, nurse practitioners, and physician assistants on the hospital medicine service at a large urban academic tertiary care center. We followed the SQUIRE 2.0 guidelines for reporting on quality improvement.Main measuresPrimary outcome measures included number of NBL prescriptions and use of nonspecific descriptors (e.g., “other” or “unknown”) for PCN allergy reaction type, and were compared with a pre-intervention period.Key resultsThe percent of β-lactam prescriptions for patients with a PCN allergy after the intervention increased from 19 to 23% (p = 0.006). For patients with a low severity PCN allergy, the percent of β-lactam prescriptions increased from 20 to 28% (p = 0.001). There was a significant decrease in nonspecific PCN allergy reaction type from 23% in the pre-intervention period to 20% post-intervention (p = 0.012).ConclusionsAn intervention focused on educating prescribers and CDS strategies delivered through the EMR increased appropriate β-lactam prescribing for patients with a documented low-risk PCN allergy and reduced the use of nonspecific PCN allergy reaction type in EMR documentation.

Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy.

Helicobacter pylori is among the prevalent causes of infections worldwide, and its resistance rate to antibiotics has been rising over time. Amoxicillin is the cornerstone for the treatment regimen. However, the prevalence of penicillin allergy ranges from 4% to 15%. In patients with true allergy, Vonoprazan-Clarithromycin-Metronidazole and bismuth quadruple therapy have demonstrated excellent eradication and high adherence rates. Vonoprazan-based therapy is administered less frequently and may be better tolerated than bismuth quadruple therapy. Therefore, vonoprazan-based therapy may be considered as a first-line therapy if accessible. Bismuth quadruple therapy can be used as the initial therapy when vonoprazan is unavailable. Levofloxacin or sitafloxacin-based regimens achieve a moderately high eradication rate. However, these are associated with potentially serious adverse effects and should only be used when other effective and safer regimens are unavailable. Cephalosporins such as cefuroxime have been used as an alternative to amoxicillin. Microbial susceptibility studies can guide the selection of appropriate antibiotics. PPI-Clarithromycin-Metronidazole fails to achieve a high eradication rate and should be used as a second-line therapy. PPI-Clarithromycin-Rifabutin should not be used because of low eradication rate and frequent adverse reactions. The choice of the most effective antibiotic regimen can enhance clinical outcomes in patients with H. pylori infection and penicillin allergy.

Microbiologic and Clinical Description of Postoperative Central Nervous System Infection After Endoscopic Endonasal Surgery

Consensus guidelines for antibiotic prophylaxis in endoscopic endonasal surgery (EES) have not been developed. The study objective was to define the microbiologic and clinical characteristics of post-EES central nervous system (CNS) infections. This was a single-center retrospective study of patients >18 years of age who underwent EES between January 2010 and July 2021 at a high-volume skull base center. Patients with confirmed CNS infection within 30 days of EES were included. During the study period, the standard prophylaxis regimen was ceftriaxone 2 g every 12 hours for 48 hours. For patients with a documented penicillin allergy, vancomycin plus aztreonam was recommended. In total, 2440 EES procedures were performed on 2005 patients; the CNS infection rate was 1.8% (37/2005). CNS infections were more common among patients with a history of previous EES (6.5%; 20/307) compared with those who did not (1%; 17/1698; P < 0.001). The median time from EES to CNS infection was 12 (6-19) days. Thirty-two percent (12/37) of CNS infections were polymicrobic, which was more common among patients without previous EES (52.9%; 9/17) compared with those with previous EES (15%; 3/20; P= 0.03). Across all cases, Staphylococcus aureus (n= 10) and Pseudomonas aeruginosa (n= 8) were commonly isolated pathogens. Among those with confirmed methicillin-resistant Staphylococcus aureus (MRSA) nares colonization before EES, 75% (3/4) developed MRSA CNS infections compared with 6.1% (2/33) of noncolonized patients (P= 0.005). CNS infection after EES is rare and causative pathogens vary. Further studies are needed to identify the impact of MRSA nares screening on antimicrobial prophylaxis before EES.

MP34-17 ANTIBIOTIC PROPHYLAXIS AT THE TIME OF CATHETER REMOVAL REDUCES HOSPITALIZATIONS DUE TO UTI: A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP34-17 ANTIBIOTIC PROPHYLAXIS AT THE TIME OF CATHETER REMOVAL REDUCES HOSPITALIZATIONS DUE TO UTI: A PROSPECTIVE RANDOMIZED STUDY Omri Schwarztuch Gildor, Amir Buchler, Yarden Fleischer, Nadav Milk, Asaf Fishelevitz, Baruch Popovtzer, Michal Chowers, Ilan Leibovitch, and Itay Sternberg Omri Schwarztuch GildorOmri Schwarztuch Gildor More articles by this author , Amir BuchlerAmir Buchler More articles by this author , Yarden FleischerYarden Fleischer More articles by this author , Nadav MilkNadav Milk More articles by this author , Asaf FishelevitzAsaf Fishelevitz More articles by this author , Baruch PopovtzerBaruch Popovtzer More articles by this author , Michal ChowersMichal Chowers More articles by this author , Ilan LeibovitchIlan Leibovitch More articles by this author , and Itay SternbergItay Sternberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a lack of consensus regarding the need to administer antibiotic prophylaxis (AP) at the time of catheter removal after urologic surgery. According to AUA guidelines, AP may be considered at the time of catheter removal. This guideline is based on low-quality evidence with a high risk of bias. The purpose of this study is to examine whether AP reduces symptomatic UTIs and hospitalizations after catheter removal. METHODS: Patients undergoing elective urologic surgery were enrolled to this prospective trial and randomized 1:1 to treatment vs control groups. A single dose of P.O. AP was administered to patients in the treatment group 1 hour before catheter removal. The antibiotic of choice was cefuroxime axetil 500 mg. In case of known penicillin allergy or pre-operative urine culture with cefuroxime-resistant bacteria, trimethoprim/sulfamethoxazole 160/800 mg was used. Development of UTI and side effects were assessed through a telephone survey performed 30 days after catheter removal. RESULTS: 211 patients were recruited and randomized: 106 and 105 to the treatment and control groups, respectively. No significant differences were found between groups regarding patients’ demographics, medical history, preoperative culture, operation type, and other parameters (see Table 1). 101 patients in the treatment group and 96 patients in the control group were eligible for analysis. A statistically significant reduction was found in self-reported dysuria. Although no significant reduction was found in the overall readmission rate, a statistically significant reduction was found in the rate of readmissions due to febrile UTI (7.3% vs 1.0%, p=0.032). No differences were found in adverse effects between groups. CONCLUSIONS: AP at the time of catheter removal reduces the frequency of re-hospitalizations due to fever and UTI-related symptoms after urological operation. Source of Funding: self funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e465 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Omri Schwarztuch Gildor More articles by this author Amir Buchler More articles by this author Yarden Fleischer More articles by this author Nadav Milk More articles by this author Asaf Fishelevitz More articles by this author Baruch Popovtzer More articles by this author Michal Chowers More articles by this author Ilan Leibovitch More articles by this author Itay Sternberg More articles by this author Expand All Advertisement PDF downloadLoading ...

The effect of reported penicillin allergy on length of stay for patients admitted to internal medicine services

Introduction: Penicillin allergy is the most common medication allergy reported in the United States; however, &gt;90% of these patients can tolerate penicillins. Reported penicillin allergy is associated with increased morbidity and mortality for patients. This retrospective, observational study evaluates the effect of reported penicillin allergy on length of stay (LOS) for adult patients admitted to the internal medicine services of a tertiary care, academic medical center. Materials and Methods: We evaluated adult patients admitted to internal medicine services from June 2014 to June 2019 comparing those who reported penicillin allergy to those who did not. Patients who did not receive antibiotics were excluded. Univariate analyses were performed on multiple demographic and clinical variables between patients who do and do not report a penicillin allergy. Multivariable linear regression was used to model the effect of reported penicillin allergy on LOS. Results: 14,144 patients were admitted to internal medicines services during the study period, with 8697 patients receiving an antibiotic during their admission. 10.5% of these patients reported a penicillin allergy. The unadjusted mean LOS for patients who report penicillin allergy was 10.4 days, while the unadjusted mean LOS for patients who do not report penicillin allergy was 9.3 days. Adjusting for covariates, the estimated LOS for patients who report penicillin allergy was 11.1 days, while the estimated LOS for patients who do not report penicillin allergy was 9.5. Conclusions: A reported penicillin allergy is associated with an increase in estimated LOS of 1.6 days. The following core competencies are addressed in this article: Systems-based practice, Medical knowledge.

The PEN-FAST+: Two additional criteria to improve negative predictive value for the penicillin allergy clinical decision rule PEN-FAST in adults

The PEN-FAST+: Two additional criteria to improve negative predictive value for the penicillin allergy clinical decision rule PEN-FAST in adults

Auf Betalaktamantibiotika bei anamnestischer „Penicillinallergie“ verzichten?

AbstractDrug allergies are frequently reported by patients undergoing pre-anesthesia evaluation, potentially resulting in a suboptimal treatment with alternative substances. While about 10% of patients report to be allergic to penicillin, less than 1% have a true IgE-mediated allergy. Multiple factors contribute to this large prevalence, such as misinterpretations of common gastrointestinal side effects as “allergic”, a history of penicillin treatment for infectious mononucleosis resulting in skin rashes, uncritical acceptance of the diagnosis by medical staff or neglect to the fact that most patients will lose their sensitivity after 10 years. In addition to this, cephalosporins are regularly withheld from patients with penicillin allergy due to an unwarranted fear of cross-reactivity. Therefore, a correct identification of those in which penicillins or cephalosporins are truly contraindicated is paramount to avoid an unnecessary use of antibiotics with a less favorable spectrum.

MP08-05 PHASE 1a/b STUDY OF INTRAVESICAL INSTILLATION OF TARA-002 IN ADULTS WITH HIGH-GRADE NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP08-05 PHASE 1a/b STUDY OF INTRAVESICAL INSTILLATION OF TARA-002 IN ADULTS WITH HIGH-GRADE NON-MUSCLE INVASIVE BLADDER CANCER William Tabayoyong, Edward Messing, Sima Porten, Donald Lamm, Jathin Bandari, Jacqueline Zummo, Wei Sun, Khushboo Belani, Andrea DiFiglia, Eppie Brown, McKenna Metcalf, and Nuwan Nanayakkara William TabayoyongWilliam Tabayoyong More articles by this author , Edward MessingEdward Messing More articles by this author , Sima PortenSima Porten More articles by this author , Donald LammDonald Lamm More articles by this author , Jathin BandariJathin Bandari More articles by this author , Jacqueline ZummoJacqueline Zummo More articles by this author , Wei SunWei Sun More articles by this author , Khushboo BelaniKhushboo Belani More articles by this author , Andrea DiFigliaAndrea DiFiglia More articles by this author , Eppie BrownEppie Brown More articles by this author , McKenna MetcalfMcKenna Metcalf More articles by this author , and Nuwan NanayakkaraNuwan Nanayakkara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003223.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer is the most common malignancy involving the urinary system, resulting in ∼18,000 US deaths/year; ∼70% of new urothelial bladder cancer cases are classified as non-muscle invasive bladder cancer (NMIBC). TARA-002 is a lyophilized biological preparation for instillation containing cells of Streptococcus pyogenes (Group A, type 3) Su strain treated with benzylpenicillin and is being developed for the treatment of high-grade (HG) NMIBC. TARA-002 is manufactured using the same master cell bank as OK-432 (Picibanil®). OK-432 is approved in Japan and Taiwan for the treatment of several oncology indications. We report on the design and progress of study ADVANCED-1 (NCT05085977; NCT05085990). METHODS: ADVANCED-1 is a P1a/b, dose finding, open-label study of intravesical TARA-002 in adults ≥ 18 yrs with HG NMIBC. The purpose of 1a dose escalation is to establish the maximum tolerated dose (MTD) and recommended P2 dose (RP2D) for the treatment of HGTa or CIS NMIBC (±Ta). The purpose of 1b dose expansion is to evaluate the anti-tumor activity and safety of induction ± re-induction of TARA-002 for the treatment of CIS NMIBC (±Ta/T1) with active disease at the established RP2D. 1a includes up to 18 subjects at 3 doses (10 KE, 20 KE, 40 KE) in a 3+3 design; 1b includes ∼102 subjects enrolled in 2 cohorts based on prior BCG experience: Cohort A includes subjects unable to obtain BCG and BCG-exposed subjects who have not received BCG in the last 24 months; Cohort B includes subjects with BCG unresponsive CIS. Those with a history of penicillin allergy or current evidence of any condition, therapy, or laboratory abnormality that might confound the results are excluded. The duration is 12 weeks per subject for 1a (includes induction), 6 months per subject for 1b-Cohort A (includes induction, reinduction [if applicable]), and 24 months per subject for 1b-Cohort B (includes induction; reinduction [if applicable]; maintenance until 18 months). RESULTS: In the 1a, at the time of writing, 3 subjects (2 female; 1 male) 66-80 yrs have completed treatment with TARA-002 at 10 KE with no dose limiting toxicities (DLT), and enrollment at 20 KE is ongoing. CONCLUSIONS: The 1a will establish the RP2D of TARA-002 and 1b will provide further evidence of anti-tumor activity and safety of TARA-002. Source of Funding: Protara Therapeutics, Inc. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e94 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information William Tabayoyong More articles by this author Edward Messing More articles by this author Sima Porten More articles by this author Donald Lamm More articles by this author Jathin Bandari More articles by this author Jacqueline Zummo More articles by this author Wei Sun More articles by this author Khushboo Belani More articles by this author Andrea DiFiglia More articles by this author Eppie Brown More articles by this author McKenna Metcalf More articles by this author Nuwan Nanayakkara More articles by this author Expand All Advertisement PDF downloadLoading ...

A potential cost savings analysis of a penicillin de-labeling program.

Over 95% of patients documented as penicillin allergic can tolerate a penicillin without a reaction. Inaccurate documentation of penicillin allergy leads to more expensive alternative antibiotic prescriptions and an increased incidence of resistant infections. To understand the potential drug cost savings of a penicillin de-labeling program to a healthcare system. We evaluated patient visits with documented penicillin allergy who presented to the pediatric Emergency Department (PED) and 22 associated primary care clinics. Patients were included if they were discharged home with a non-penicillin antibiotic when the first-line treatment for the diagnosis would have been a penicillin. The potential cost savings were the sum of all visit-level cost differences between the non-penicillin prescription(s) and a counterfactual penicillin prescription. To factor in a 95% successful patient de-labeling rate, we repeatedly sampled 95% from the patients with the eligible visits 10,000 times to produce an estimate of the potential cost savings. Over the 8-year period, 2,034 visits by 1,537 patients to the PED and 12,349 visits by 6,073 patients to primary care clinics satisfied eligibility criteria. If 95% of the patients could have been successfully de-labeled, it would have generated a cost saving of $618,653 (95% CI $618,617-$618,689) for all the corresponding payers in the system. Implementing a penicillin de-labeling program across a healthcare system PED and its associated primary care clinics would bring significant cost savings. Healthcare systems should rigorously evaluate optimal methods to de-label patients with reported penicillin allergy.

CATALYST: challenging antibiotic allergy status.

To develop a transferable process, CATALYST (challenging antibiotic allergystatus), to assess and challenge penicillin allergy status of inpatients within an NHS Foundation Hospital. A multidisciplinary team (MDT) steering group reviewed existing literature and protocols enabling penicillin allergy assessment, challenge and de-labelling. Using this, they identified five key steps forming the basis of CATALYST: clinical assessment of the nature of allergy; inclusion/exclusion criteria; consent; direct oral penicillin challenge; and removal of allergy label. A pharmacist-led pilot was conducted to assess the process, during which a continuous PDSA (plan-do-study-act) cycle was observed. This included formally auditing endpoint data such as accuracy of allergy status in medical records post-intervention. CATALYST was successfully developed with key resources produced to support clinicians. It was piloted in 304 patients, with 172 patients excluded and 132 successful allergy challenges. There was one incident of an adverse event (acute kidney injury) in the 132 successful patients, which occurred as a delayed reaction following 22 days of penicillin therapy. Only 64% of permanent records (held by GP) were appropriately updated when audited at the end of the pilot. CATALYST is a transferable process to facilitate safe assessment, challenge and removal of spurious penicillin allergy labels. Handover between care sectors forms a key element of allergy removal to ensure all records are updated and work is needed to ensure this process is done effectively.

Parental perspective on penicillin allergy delabeling in a pediatric emergency department

BackgroundPenicillin (PCN) allergy is frequently mislabeled and inaccurately diagnosed in children. Successful implementation of pediatric emergency department (PED) delabeling efforts requires parental understanding and willingness for children to be delabeled as PCN-nonallergic. ObjectiveTo describe the parental perspective on allergy delabeling in the PED for children identified as low risk for true PCN allergy. MethodsThis is a cross-sectional survey of parents of children with documented PCN allergy presenting to a single tertiary-care PED. Parents were first approached to complete a PCN allergy identification questionnaire to stratify their child as high- or low-risk for true PCN allergy. Facilitators and barriers to PED-based oral challenge and delabeling were subsequently assessed by parents of low-risk children. ResultsA total of 198 participants completed the PCN identification questionnaire. Of 198 children, 49 (25%) screened low risk for true PCN allergy. Of the 49 low-risk children, 29 (59%) parents were uncomfortable with a PED-based PCN oral challenge. Reasons include fear of allergic reaction (72%), availability of adequate alternative antibiotics (45%), and longer PED stay (17%). Reasons for willingness to delabel included PCN's low adverse effect profile (65%) and avoidance of antimicrobial resistance from alternative antibiotics (74%). Participants without a family history (FH) of PCN allergy were more comfortable with PED-based PCN oral challenge (60% vs 11%; P = .001) and delabeling (67% vs 37%; P = .04) compared with those with FH. ConclusionMost parents of children with low-risk PCN allergy are uncomfortable with oral challenge or delabeling in the PED. Before implementing oral challenges in PEDs, efforts should be made to highlight the safety of oral challenging low-risk children, the benefits and risks of alternative antibiotics, and the minimal impact that FH has on PCN allergy.

Penicillin allergy delabelling in pregnancy.

Although 10% of patients who are pregnant report having a penicillin allergy,[1][1] after evaluation, 83%–95% of these patients can safely receive penicillin.[2][2],[3][3] Penicillin allergy delabelling is associated with the prevention of antibiotic resistance and Clostridium difficile infection

Penicillin allergy delabelling of patients at risk of sexually transmitted infections in primary care.

[See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.220973][1] KEY POINTS In North America, a penicillin allergy is reported by about 10% of patients.[1][2] In relation to sexual health and sexually transmitted infections (STIs), this is especially important with the resurgence of syphilis

Administration of β-lactam antibiotics to patients with reported penicillin allergy in the emergency department

Backgroundβ-lactam antibiotics are amongst the most commonly prescribed medications in the Emergency Department (ED) due to their role in empiric sepsis therapy; however, inferior therapeutic options are often utilized due to a reported allergy; penicillin (PCN) being most frequent. In the United States, 10% of the population endorses an allergic reaction to PCN while <1% experience IgE-mediated reactions. This study aimed to evaluate the frequency and outcome of patients in the ED whose PCN allergies were challenged with β-lactam antibiotics. MethodsWe conducted a retrospective chart review of patients in the ED at an academic medical center aged ≥18, and who received a β-lactam despite a reported PCN allergy between January 2015 and December 2019. Patients who did not receive a β-lactam or did not report a PCN allergy prior to administration were excluded. The primary outcome was the frequency of IgE-mediated reactions in response to β-lactam administration. A secondary outcome assessed the frequency of continuation of β-lactams upon admission from the ED. Results819 patients were included (66% female) with prior reported PCN reactions: hives (22.5%), rash (15.4%), swelling (6.2%), anaphylaxis (3.5%), other (12.1%), or undocumented on medical electronic record (40.3%). No patients experienced an IgE-mediated reaction to the β-lactam administered in the ED. Previously reported allergies had no effect on the continuation of β-lactams when admitted or discharged (OR: 1, 95% CI: 0.7–1.44). Patients who had a history of an IgE-mediated penicillin allergy were frequently continued (77%) on a β-lactam after leaving the ED via admission or discharge. Conclusionβ-lactam administration in patients with previously reported PCN allergies did not result in any IgE-mediated reactions nor in an increase in adverse reactions. Our data contributes to the body of evidence that supports the administration of β-lactams to patients with documented PCN allergies.