REGIMENS IN PATIENTS WITH PENICILLIN ALLERGY CLAYTON FITZPATRICK, LEO BRANCAZIO, TERRENCE ALLEN, GEETA SWAMY, PHILLIP HEINE, Duke University, Obstetrics and Gynecology, Durham, North Carolina, Duke University, Women’s Anesthesia, Durham, North Carolina, Duke University, Obstetrics & Gynecology, Durham, North Carolina OBJECTIVE: The American College of Obstetricians and Gynecologists has advocated a culture based screening protocol implemented at 35-37 weeks for prevention of early onset GBS sepsis in the neonate. Because of increasing microbial resistance to second line agents such as clindamycin and erythromycin, it is recommended that all patients at risk for anaphylactic reactions to penicillin undergo susceptibility testing on rectovaginal cultures obtained at 35-37 weeks. Our objective is to use decision analysis software to compare the direct costs of susceptibility testing with appropriate selection of antibiotics to prophylaxis using vancomycin. STUDY DESIGN: Cost of GBS prophylaxis with clindamycin, erthythromycin, and vancomycin were determined over the course of an average labor using data from Duke University Hospital. These data were also used to determine cost of susceptibility testing for GBS positive rectovaginal cultures. Data regarding probability and direct cost of anaphylaxis with the previously mentioned drugs, as well as the probability and direct cost of GBS sepsis in the neonate were determined by literature review. These data were then incorporated into a decision model comparing the direct cost of a treatment strategy using susceptibility testing versus the direct cost of using only vancomycin. RESULTS: The direct cost per patient of susceptibility testing followed by selection of clindamycin, erythromycin or vancomycin based on 90% sensitivity to clindamycin, 80% sensitivity to erythromycin, and 100% sensitivity to vancomycin was $1310.00. The direct cost of treatment with vancomycin was $1040.89. Sensitivity analysis revealed that treatment with vancomycin without susceptibility testing remained the most cost effective strategy despite varying levels of resistance to all three antibiotics. CONCLUSION: It is more cost effective to forgo susceptibility testing in favor of prophylaxis with vancomycin in patients with GBS positive cultures and a true penicillin allergy.