Collaboration between Allergists and Pharmacists Increases β-Lactam Antibiotic Prescriptions in Patients with a History of Penicillin Allergy

Abstract

Background: Over 90% of patients with a history of penicillin allergy have negative penicillin skin tests. Pharmacists are trained to identify and resolve medication-related problems. We hypothesized that collaboration between allergists and pharmacists to identify and evaluate patients with a history of penicillin allergy would increase β-lactam antibiotic prescription. Methods: We conducted a prospective observational study in which patients with a history of penicillin allergy were identified and educated at the pharmacy about penicillin allergy and offered an allergist consultation with a penicillin skin test. All patients were followed up to determine which antibiotics were subsequently prescribed. Results: A total of 503 patients were enrolled, and 71 (14%) were evaluated by an allergist. Sixty-seven of these 71 patients (94%) had a negative penicillin skin test. Twenty-nine patients evaluated by an allergist and 205 patients not evaluated were prescribed antibiotics. Patients prescribed antibiotics and evaluated by an allergist were compared to those not evaluated by an allergist, with the following results: 19 of 29 patients (66%) were prescribed a β-lactam antibiotic compared to 54 of 205 (26%; p < 0.0001); 8 of 29 patients (28%) were prescribed penicillin compared to 7 of 205 (3%; p < 0.0001); 15 of 29 patients (52%) were prescribed a cephalosporin compared to 48 of 205 (23%; p < 0.01), and 10 of 29 patients (34%) were prescribed a non-β-lactam antibiotic compared with 177 of 205 (86%; p < 0.0001). Conclusion: A collaborative effort between allergists and pharmacists can increase β-lactam antibiotic prescriptions and decrease non-β-lactam prescriptions in patients with a history of penicillin allergy.

The 3 Cs of Antibiotic Allergy—Classification, Cross-Reactivity, and Collaboration

“…71, 144, 145 Small pilot studies have demonstrated pharmacy led referral systems, antibiotic allergy stewardship rounds, and direct oral provocation programs can safely increase simple beta-lactam use and reduce restricted antibiotic usage and hospital costs. 14, 63, 126, 135, 146–152 Recent published experiences with inpatient allergy testing, either pharmacist, allergist or infectious diseases led, have also demonstrated improved uptake of preferred beta-lactam therapies. 134, 153–155 Targeted antimicrobial stewardship programs have demonstrated a reduction in restricted antibiotic usage, with such an intervention.…”

Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network

“…Recent studies have highlighted increased use of restricted antibiotics and inappropriate prescriptions in those with antibiotic allergy labels [2]. The engagement of hospital pharmacists is essential; programs using direct allergy referrals from pharmacy departments have aided delabeling initiatives [12, 20]. A multidisciplinary model involving allergists, immunologists, ID physicians, and pharmacists is most likely to engage clinicians and deliver an effective service [21].…”

Antimicrobial stewardshipʼs new weapon? A review of antibiotic allergy and pathways to ‘de-labeling’

“…Park et al [89] demonstrated that pharmacist-facilitated referral to allergists can increase β-lactam antibiotic prescriptions in patients with a reported penicillin allergy, as 94% of patients referred to an allergist were SPT/IDT-negative. Furthermore, 66% of those referred to an allergist were subsequently prescribed a β-lactam compared with 26% who were not referred ( P <0.0001).…”