Beta-lactam allergy in patients: an antibiotic stewardship challenge

Abstract

BackgroundPatients are commonly reported as being allergic to beta-lactam (BL) antibiotics. However, many patients with this reported allergy are able to receive BL treatments because they do not have true allergies. In many cases these are simply intolerances due to side effects reported as an allergy. Delabelling these patients leads to better clinical outcomes, optimal antibiotic usage, decreased bacterial resistance and reduced healthcare costs. Therefore, the aims of this study were to identify incorrectly labelled BL allergies in hospitalised patients and to assess antibiotic use in delabelled patients in order to establish a quality indicator to optimise antimicrobial treatments.MethodsA prospective study was conducted in which hospitalised patients treated with antimicrobial drugs and labelled as ‘BL-allergic’ were identified by clinical pharmacists. An allergist assessed whether patients were suitable candidates for a skin test or oral challenge. The Allergy Service removed ‘BL-allergic’ labels if negative results were obtained. Delabelled patients were followed up by clinical pharmacists to study the use of BL antibiotics as a result of the delabelling programme.ResultsA total of 176 suspected allergic patients were identified and 91 (51.7%) were tested either by a skin test or oral challenge based on the patient indicators. Seven (16.4%) patients tested were allergic to BL antibiotics, 76 (83.5%) were totally delabelled and eight (0.1%) were partially delabelled. Thirty-two (38.1%) delabelled patients required antibiotic treatment in another inpatient or outpatient setting, of whom 27 (84.3%) patients with a new infectious episode received BL treatments while five (15.7%) continued to receive antimicrobial treatments without BL.ConclusionAfter the implementation of a protocol to detect incorrect BL allergy labels, 83.5% of the patients in this cohort were completely delabelled. This shows that there is a clear opportunity to optimise the use of antibiotics by delabelling ‘BL-allergic’ patients.

How Far Are We From Achieving Delabeling of False Penicillin/ß-Lactam Allergy Alerts? A Population Problem

“…referred them to the allergy department for classic drug allergy assessment (ST and DPT). The authors reported efficacy data for 176 patients collected over 21 months that were similar to those reported for faster strategies [51] In our hospital [48], the strategy is aimed at assessing the tolerance of chosen ß-lactam through the antibiotic stewardship program. After discharge, the patient is referred to the allergy department to complete a classic study for drug allergy assessment.…”

“…Other less resolutive strategies have been assayed to enable the use of some ß-lactam antibiotics in patients with a penicillin allergy label. In a hospital in Castellon, Spain [51], pharmacists identified admitted patients with a penicillin allergy label and Table 2. Specialties and Risk for a True Allergy in the Systematic Review of Powell et al [43].…”

Integration of beta‐lactam allergy evaluation in a Spanish antibiotic stewardship programme

“…Forty-six patients (44.6%) were not delabelled for not attending the scheduled study due to advanced age, comorbidities, death or from unknown causes, data similar to the Bodega-Azuara study. 8 De-labelling based on challenge with a single dose of amoxicillin or penicillin without previous skin tests can be useful in low-risk cases, although up to 3.43% of positive cases can be found. 9 In conclusion, our study shows that the integration of allergy into the ASP group in the Spanish context safely allowed a greater prescription of first-choice antibiotics (95.3%) in hospitalized patients with a diagnosis of infection and that it was possible to withdraw or modify the label of allergy to beta-lactams in 52.7% of cases.…”