Impact of a clinical guideline for prescribing antibiotics to inpatients reporting penicillin or cephalosporin allergy

Blumenthal, Kimberly G.; Shenoy, Erica S.; Varughese, Christy; Hurwitz, Shelley; Hooper, David C.; Banerji, Aleena

doi:10.1016/j.anai.2015.05.011

Cited by 152 publications

(138 citation statements)

References 51 publications

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“…Such hospital-wide guidelines, when applied to penicillin allergy, enable primary care providers to determine when and how to use penicillin or other β-lactams before considering a full skin test. In recent studies, CDS increased β-lactam use while concurrently lowering that of alternative agents, with the potential benefit of preserving PAST resources for patients with stronger clinical indications [25, 26]. …”

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confidence: 99%

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Chen

Tarver

Alvarez

et al. 2018

Open Forum Infectious Diseases

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BackgroundPatients reporting penicillin allergy often receive unnecessary and costly broad-spectrum alternatives such as aztreonam with negative consequences. Penicillin allergy testing improves antimicrobial therapy but is not broadly used in hospitals due to insufficient testing resources and short-term expenses. We describe a clinical decision support (CDS) tool promoting pharmacist-administered penicillin allergy testing in patients receiving aztreonam and its benefits toward antimicrobial stewardship and costs.MethodsA CDS tool was incorporated into the electronic medical record, directing providers to order penicillin allergy testing for patients receiving aztreonam. An allergy-trained pharmacist reviewed orders placed through this new guideline and performed skin testing and oral challenges to determine whether these patients could safely take penicillin. Data on tests performed, antibiotic utilization, and cost-savings were compared with patients tested outside the new guideline as part of our institution’s standard stewardship program.ResultsThe guideline significantly increased penicillin allergy testing among patients receiving aztreonam from 24% to 85% (P < .001) while reducing the median delay between admission and testing completion from 3.31 to 1.05 days (P = 0.008). Patients tested under the guideline saw a 58% increase in penicillin exposure (P = .046). Institutional aztreonam administration declined from 2.54 to 1.47 administrations per 1000 patient-days (P = .016). Average antibiotic costs per patient tested before and after CDS decreased from $1265.81 to $592.08 USD, a 53% savings.ConclusionsTargeting penicillin allergy testing to patients on aztreonam yields therapeutic and economic benefits during a single admission. This provides a cost-effective model for inpatient testing.

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confidence: 99%

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Chen

Tarver

Alvarez

et al. 2018

Open Forum Infectious Diseases

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“…Since April 2013, MGH has not required allergy consultation prior to beta-lactam antibiotic test doses (including ceftaroline) because of an inpatient standardized guideline. 23 …”

Section: Methodsmentioning

confidence: 99%

Adverse Drug Reactions Associated with Ceftaroline Use: A 2-Center Retrospective Cohort

Blumenthal

Kuhlen

Weil

et al. 2016

The Journal of Allergy and Clinical Immunology: In Practice

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Background Ceftaroline fosamil is a cephalosporin approved for treating skin and soft tissue infections (SSTIs), including those caused by methicillin-resistant Staphylococcus aureus (MRSA) and community acquired pneumonia (CAP). Objective We aimed to study ceftaroline use and associated adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs), among inpatients. Methods We performed a retrospective electronic health record review of inpatients from Massachusetts General Hospital and Brigham and Women’s Hospital who received ceftaroline between May 2012 and February 2015. ADRs diagnosed by clinical providers during the course of clinical care were subsequently verified and classified. Risk factors for ADRs were identified. Results Among 96 patients (median age 57 years, 54% female) who received a median of 28 [IQR 6, 63] ceftaroline doses, 54% were being treated for MRSA and treatment indications other than SSTI and CAP comprised 59% of care. There were 31 ADRs observed in 20 (21%) of patients; hematologic (n=15) and cutaneous (n=9) findings were most common. Observed HSRs included rash with mucosal lesions (n=1), rash with skin desquamation (n=1) and possible organ specific HSRs (n=2). Patients who suffered an ADR received more doses of ceftaroline (median 46 vs. 21, p=0.013). There was no increased risk of ceftaroline ADR among patients with prior reported beta-lactam allergy (p >0.5). Conclusions Ceftaroline is used to treat a range of infections beyond SSTI and CAP. We observed a high rate of ADRs from ceftaroline, including signs of severe HSRs. More data are needed to understand the frequency and predictors of ceftaroline ADRs and HSRs.

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“…4 Compared to patients without a penicillin allergy record, those with such a penicillin allergy record are exposed to a greater number of antibiotics, experience increased length of hospital stay, increased hospital readmission rates and increased risk of dying. 5,6 An additional concern is that many of the new antibacterial agents in development are beta-lactams and a patient inappropriately labelled as penicillin allergic may be denied these new agents unnecessarily.…”

Section: Introductionmentioning

confidence: 99%

A UK hospital survey to explore healthcare professional views and attitudes to patients incorrectly labelled as penicillin allergic: an antibiotic stewardship patient safety project

2018

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Impact of a clinical guideline for prescribing antibiotics to inpatients reporting penicillin or cephalosporin allergy

Cited by 152 publications

References 51 publications

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline

Adverse Drug Reactions Associated with Ceftaroline Use: A 2-Center Retrospective Cohort

A UK hospital survey to explore healthcare professional views and attitudes to patients incorrectly labelled as penicillin allergic: an antibiotic stewardship patient safety project

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