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Impact of parent-reported antibiotic allergies on pediatric Antimicrobial Stewardship Programs

Published online January 10, 2025

With rising antimicrobial resistance and slowing drug development, antimicrobial stewardship (AMS) plays a crucial role in optimizing antibiotic use, reducing resistance, and enhancing patient outcomes. Parent-reported, but not specialist confirmed, penicillin and cephalosporin beta-lactam allergies are the most common drug allergies in children and are likely to directly interfere with optimal AMS. However, this impact has yet to be formally demonstrated.

The study by Arnold et al. (2024) published in The Journal of Allergy and Clinical Immunology: In Practice, retrospectively investigated 1,590 children, admitted as inpatients and reviewed by the AMS in a major Australian pediatric tertiary hospital between October 2017 and April 2019. All patients were prescribed at least one antibiotic. Data collected included parent reported and documented antibiotic allergy labels (AAL), antibiotic AMS prescriptions, principal diagnosis, admitting specialty, hospital length of stay, intensive care admissions and hospital readmissions. 

In the AMS cohort, 6.6% of children carried an AAL, mostly for beta-lactams (82%), specifically penicillins (71%). AAL reporting increased with age (p<0.001); no gender effect was seen. AMS children with AALs received more quinolones (p<0.001), lincosamides (p=0.001), aminoglycosides (p<0.001), and metronidazole (p=0.015), than patients with no AALs. In contrast, children with no AAL received more penicillin (p<0.001). AMS children with any AAL had longer hospital length of stay, median (IQR) 7.0 (4.0, 15.0) days, than those without (median (IQR) 5.0 (3.75, 11.0) days, p=0.027). Comparatively to a previous study by the same authors on a general inpatient cohort, children with AAL in AMS had a significantly higher unspecified penicillin allergies (OR 2.788, 95% CI 1.315–6.434, p=0.004) and allergies to piperacillin-tazobactam (OR 5.005, 95% CI 1.885–16.734, p<0.001). In the general inpatient study, only 0.3% of children had more than one AAL. In the AMS cohort, this had risen to 19.0%, with 4.7% reporting more than two allergies. Those with an AAL also had increased length of stay, which was longer for the AMS cohort: 7 days versus 5 days (HR 0.79, 95% CI 0.65, 0.97, p=0.02) compared to general inpatients, and 5 days versus 3.8 days (OR 1.59; 95% CI 1.03-2.28; p=0.04). This study is the first to show how AALs impact clinical outcomes in children under an AMS program. With advances in delabeling, early intervention in cases of AAL should target children under AMS services who are in immediate need of optimal antibiotic management.

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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