Penicillin allergy is associated with worse outcomes in COVID-19

Published: July 19, 2021

During the coronavirus disease-2019 (COVID-19) pandemic, antibiotic use has been common when there is concern for possible or proven concurrent bacterial infection. Penicillin (PCN) allergy can impact antibiotic choices and put the patient at risk of poorer response to treatment and increased side effects. Although PCN allergy is a common antibiotic allergy, once evaluated, the majority of patients are cleared of PCN allergy.

In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Kaminsky et al. investigated outcomes in PCN allergic patients with COVID-19 using a de-identified healthcare research network. Adult patients diagnosed with COVID-19 with and without PCN allergy were matched on demographics and on comorbid conditions associated with more severe illness in COVID-19. The outcomes included the 30-day risk of hospitalization, acute respiratory failure, need for intensive level of care, need for mechanical ventilation, mortality, and bacterial infection after COVID-19 diagnosis. The use of antibiotics in these patients was also explored.

PCN allergy was associated with a 1.5-fold increased risk of being hospitalized, a 1.2-fold increased risk of acute respiratory failure, a 1.2-fold increased risk of needing intensive level of care, and a 1.2-fold increased risk of needing mechanical ventilation within 30 days of COVID-19 diagnosis compared to patients without a PCN allergy. There was no difference in mortality between the 2 groups. Although there was increased rates of bacterial infection for the PCN allergic patients, exclusion of patients with bacterial infection had similar results indicating that differences in outcomes for the groups was not due to concurrent bacterial infection. The rate of antibiotic use in patients with COVID-19 was greater than the rate of diagnosed bacterial infection. In PCN allergic patients, there was decreased use of PCN antibiotics but greater use of other classes of antibiotics, including carbapenems and quinolones, compared to patients without PCN allergy. Due to the increased risk of hospitalization, acute respiratory failure, intensive level of care, and mechanical ventilation in COVID-19 patients with PCN allergy, this study suggests that patients with PCN allergy may benefit from risk mitigation strategies, such as antibiotic stewardship programs and PCN allergy evaluation, in the setting of COVID-19.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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