Enhancing antibiotic stewardship by tackling “spurious” penicillin allergy |
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| Authors: | M. T. Krishna A. P. Huissoon M. Li A. Richter D. G. Pillay D. Sambanthan S. C. Raman S. Nasser S. A. Misbah |
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| Affiliation: | 1. Department of Allergy and Immunology, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK;2. Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK;3. Department of Microbiology, University Hospital of Coventry and Warwickshire, Coventry, UK;4. Clinical Immunology Service, Birmingham Medical School, University of Birmingham, Edgbaston, Birmingham, UK;5. Department of Microbiology, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK;6. Tata Consultancy Services Ltd, Thoraipakkam, Chennai, India;7. Department of Allergy, Cambridge University Hospitals, Cambridge, UK;8. Department of Clinical Immunology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK |
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| 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, methicillin‐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 healthcare professionals, we describe the potential role for a computerized clinical decision support system to enable non‐specialists rapidly identify and de‐label “low‐risk” hospitalized patients with a label of PenA thereby obviating the need for allergy tests. This approach however needs rigorous evaluation for feasibility, safety, patient and physician acceptability, cost‐effectiveness and its compatibility with information technology systems currently employed in the health service. |
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