Published Online: April 28, 2016
Suspected penicillin allergy is a common cause for deviations of antibiotic treatment protocols and consumption of broad spectrum ‘reserve antibiotics’. However, this suspected penicillin allergy is often not verified or excluded by diagnostic testing.
In a recently published article in The Journal of Allergy and Clinical Immunology: in Practice van Dijk and colleagues report the prevalence of a suspected penicillin allergy in a large Dutch tertiary university medical hospital and its impact on antibiotic use in hospitalized patients. Patients admitted between July 2013 and July 2014 who underwent a standardized pharmacotherapeutic interview, including questions on medication allergy, were included in the study. Patients with a registered suspected or self-reported penicillin allergy were matched on age, sex and department of admission with up to three patients without a registered penicillin allergy. Relative risk of receiving a reserve antibiotic, death during hospitalization, and re-hospitalization were compared in the two cohorts.
Of 17,959 patients, 1010 (5.6%) patients had a penicillin allergy registration. These patients more often received reserve antibiotics (RR 1.38, 95% CI 1.22-1.56) and were also more likely to be re-hospitalized within 12 weeks (RR 1.28, 95% CI 1.10-1.49). More patients with penicillin allergy registration received reserve antibiotics such as tetracyclines (1.8% vs 0.8%), macrolides/lincosamides/streptogramins (12.5% vs 4.9%) and quinolones (7.9% vs 4.3%) or received ≥2 types of antibiotics during hospitalization (21.7% vs 16.9%) when compared with patients without penicillin allergy registration.
The report of van Dijk and colleagues shows that prevalence of penicillin allergy registration in hospitalized patients is high, has high impact on antibiotic prescribing and is associated with a higher risk of readmission. These findings emphasize the importance of verifying the diagnosis of penicillin allergy. Verification of penicillin allergy in hospitalized patients might reduce use of reserve antibiotics and improve patient outcomes.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.