Implementation of a penicillin allergy screening tool to optimize aztreonam use

Staicu, Mary L.; Brundige, Mary Lourdes; Ramsey, Allison; Brown, Jack; Yamshchikov, Alexandra; Peterson, Derick R.; Baran, Andrea; Laguio-Vila, Maryrose

doi:10.2146/ajhp150288

Cited by 33 publications

(29 citation statements)

References 25 publications

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“…134, 153–155 Targeted antimicrobial stewardship programs have demonstrated a reduction in restricted antibiotic usage, with such an intervention. 152, 156, 157 A limitation of these studies has been a focus on aztreonam use, without an examination of other restricted antimicrobials, such as carbapenems and fluoroquinolones. Pharmacist engagement is potentially under utilized, as Wall et al .…”

Section: Collaboration– New Pathways and Partnershipsmentioning

confidence: 99%

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

Trubiano

Stone

Grayson

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

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Antibiotic allergy labelling is highly prevalent and negatively impacts patient outcomes and antibiotic appropriateness. Reducing the prevalence and burden of antibiotic allergies requires the engagement of key stakeholders such as allergists, immunologists, pharmacists and infectious diseases physicians. To help address this burden of antibiotic allergy over-labelling, we review three key antibiotic allergy domains: (a) antibiotic allergy classification, (b) antibiotic cross-reactivity and (c) multidisciplinary collaboration. We review the available evidence and research gaps of currently utilized adverse drug reaction (ADR) classification systems, antibiotic allergy cross-reactivity and current and future models of antibiotic allergy care.

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Section: Collaboration– New Pathways and Partnershipsmentioning

confidence: 99%

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

Trubiano

Stone

Grayson

et al. 2017

The Journal of Allergy and Clinical Immunology: In Practice

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“…Fourteen studies showed decreases in antibiotic usage. [26,33,36,37,39,44,46,48,52,53,55–58] Two studies showed increases in antibiotic usage. [32,50] One study by Fisher and co-workers showed conflicting results as intravenous DDDs significantly decreased by 11.1% (p = 0.002), but was coupled with a compensatory increase in oral DDDs of 3.7% (p = 0.002).…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

2017

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BackgroundInappropriate antimicrobial use has been shown to be an important determinant of the emergence of antimicrobial resistance (AMR). Health information technology (HIT) in the form of Computerised Decision Support (CDS) represents an option for improving antimicrobial prescribing and containing AMR.ObjectivesTo evaluate the evidence for CDS in improving quantitative and qualitative measures of antibiotic prescribing in inpatient hospital settings.MethodsA systematic literature search was conducted of articles published from inception to 20th December 2014 using eight electronic databases: MEDLINE, EMBASE, PUBMED, Web of Science, CINAHL, Cochrane Library, HMIC and PsychINFo. An updated systematic literature search was conducted from January 1st 2015 to October 1st 2016 using PUBMED. The search strategy used combinations of the following terms: (electronic prescribing) OR (clinical decision support) AND (antibiotic or antibacterial or antimicrobial) AND (hospital or secondary care or inpatient). Studies were evaluated for quality using a 10-point rating scale.ResultsEighty-one studies were identified matching the inclusion criteria. Seven outcome measures were evaluated: adequacy of antibiotic coverage, mortality, volume of antibiotic usage, length of stay, antibiotic cost, compliance with guidelines, antimicrobial resistance, and CDS implementation and uptake. Meta-analysis of pooled outcomes showed CDS significantly improved the adequacy of antibiotic coverage (n = 13; odds ratio [OR], 2.11 [95% CI, 1.67 to 2.66, p ≤ 0.00001]). Also, CDS was associated with marginally lowered mortality (n = 20; OR, 0.85 [CI, 0.75 to 0.96, p = 0.01]). CDS was associated with lower antibiotic utilisation, increased compliance with antibiotic guidelines and reductions in antimicrobial resistance. Conflicting effects of CDS on length of stay, antibiotic costs and system uptake were also noted.ConclusionsCDS has the potential to improve the adequacy of antibiotic coverage and marginally decrease mortality in hospital-related settings.

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“…The most definitive test for de-labeling a penicillin allergy is tolerance of the drug on ingestion challenge. Tolerance of a graded two dose or single dose ingestion challenge is the gold standard to evaluate immediate hypersensitivity drug reactions.Penicillin allergy assessment by history alone utilizing validated point-of-care assessment tools93,94 can risk stratify patients and potentially directly de-label those with clearly non-immune-mediated reactions (20% of all reported penicillin allergies) 46. These approaches currently target inaccurate penicillin allergy labels placed for reasons such as nausea, vomiting, diarrhea alone, or a family history of allergy.…”

mentioning

confidence: 99%

The challenge of de‐labeling penicillin allergy

Stone

Trubiano

Coleman

et al. 2019

Allergy

153

147

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Background Even though 8%‐25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy that has waned over time. Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de‐labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus. Methods We performed an evidence‐based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de‐labeling. Over the period 1928‐2018 in Pubmed and Medline, search terms used included “penicillin allergy” or “penicillin hypersensitivity” alone or in combination with “adverse events,” “testing,” “evaluation,” “effects,” “label,” “de‐labeling,” “prick or epicutaneous,” and “intradermal” skin testing, “oral challenge or provocation,” “cross‐reactivity,” and “antimicrobial stewardship”. Results Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance. Conclusions Operationalizing penicillin allergy de‐labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de‐labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs.

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Implementation of a penicillin allergy screening tool to optimize aztreonam use

Abstract: Implementation of the PAST and provider and pharmacist education reduced the use of aztreonam by promoting the first-line use of β-lactam alternatives.

Cited by 33 publications

References 25 publications

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

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

The effectiveness of computerised decision support on antibiotic use in hospitals: A systematic review

The challenge of de‐labeling penicillin allergy

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