Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis

Abstract

Objective Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of Clostridioides difficile infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery. Methods A break‐even analysis was performed using the average cost of penicillin allergy testing and a CDI/SSI to calculate the absolute risk reduction (ARR) in baseline CDI/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR. Results Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability. Conclusion In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery. Level of Evidence NA Laryngoscope, 133:1086–1091, 2023

Management of Penicillin Allergy in the Perioperative Setting

“…Preoperative allergy assessment and/or de-labeling also involve a significant financial and time outlay. Liu et al performed an evaluation of the cost of implementing PST relative to the benefit, and they found that the degree to which performing PST made financial sense was dependent on the rates of C. difficile infection and SSIs at an institution [59]. PST supplies and training are also not always available-less than 50% of health systems have access to PST, making this approach less likely to be generalizable [60].…”

Inaccurate penicillin allergy labels: Consequences, solutions, and opportunities for rhinologists

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