Association Between Penicillin Allergy Documentation and Antibiotic Use

Abstract

that legalization of recreational marijuana is associated with increased traffic fatality rates. Applying these results to national driving statistics, nationwide legalization would be associated with 6800 (95% CI, 4200-9700) excess roadway deaths each year. Despite certain methodological differences, we found an increase similar to that reported by Aydelotte et al. 4 They reported an increase of 1.8 fatal crashes (equivalent to 2.0 fatalities) per BVMT. We concur with their opinion that changes may not be detected immediately after legalization but only after a longer time period or after commercial sales begin.We chose a control group consisting of all states with neither legal recreational nor medical marijuana to isolate the effects of marijuana. We did not require that control states have baseline attributes similar to the experimental states because the difference-in-difference technique removes biases in comparisons between experimental and control groups that result from permanent differences between those groups. Our conclusions, nonetheless, are limited by adjusting for only 3 state-specific factors that may have changed during the study period. It is possible that another confounder, rather than marijuana legalization and commercialization, caused the observed increase in roadway deaths.

Documented β-Lactam Allergy and Risk for Cesarean Surgical Site Infection

“…Given that SSI only occurred in 274 participants, we could not simultaneously account for all possible confounders in the relationship between SSI and β -lactam allergy. Together with the missing data on antibiotic administration, the prevalence of β -lactam allergy in this population is lower than that reported elsewhere, and the smoking rate is low, all of which suggest the potential for missing data in the PeriBank dataset [ 18 , 52 ]. Finally, this database includes two institutions and there may be unaccounted for institutional differences that impact antibiotic administration or reliable recording of allergies or medication administration.…”

“…Penicillin skin testing improves antibiotic choice for obstetric populations and is safe to perform during pregnancy [50][51][52]. A negative penicillin skin test carries a high predictive value (>95% that approaches 100%) when combined with an oral amoxicillin challenge [50].…”

Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement

“…Stewardship imperative for antibiotic delabeling Patient-reported antibiotic allergies (so-called antibiotic allergy labels [AALs]) are associated with the generation of antimicrobial resistance (AMR) and inferior antimicrobial stewardship (AMS) outcomes, inappropriate antibiotic usage, use of broad-spectrum and restricted antimicrobials, methicillin-resistant Staphylococcus aureus (MRSA) colonization, Clostridium difficile infection, postoperative infections, prolonged admissions, and delay to appropriate antibiotic therapies. 24,[155][156][157][158][159][160][161][162] Antibiotic allergy delabeling programs, in both immunocompetent and immunocompromised hosts, have safely been implemented into antimicrobial stewardship programs (ASP) globally, improving patient and hospital outcomes. [163][164][165][166][167][168][169] There has been a call to incorporate antibiotic allergy delabeling that includes not only delabeling penicillin but other antibiotics, and incorporating delabeling strategies for multiantibiotic labels into ASPs is supported by the recent Infectious Diseases Society of America (IDSA) guidelines.…”

An algorithm for safe de‐labelling of antibiotic allergy in adult hospital in‐patients

“…Tackling inappropriate penicillin allergy labelling is important because a “penicillin allergy” label potentially leads to the use of sub‐optimal alternative antibiotics (eg vancomycin instead of flucloxacillin) and is associated with poorer outcomes including increased risk of Clostridioides ( C) difficile , antimicrobial‐resistant infections, longer hospital stay and other adverse events 1 , 2 It is, therefore, beneficial to assess whether patients have experienced a true allergic reaction and to consider removing their allergy label. Increasing evidence supports the removal of penicillin allergy status by non‐specialists using an oral challenge test.…”