Long-term impacts of antibiotic allergy testing on patient perceptions and antibiotic utilization

Abstract

Objectives To define the long-term impacts of antibiotic allergy testing (AAT) on patient allergy perception and antibiotic utilization. Methods Patients were identified from a prospective AAT database as having completed testing during a 15 month period beginning January 2017. Patients were contacted for a follow-up survey at least 12 months post-AAT. For those contacted, baseline demographics, antibiotic allergy label (AAL) history, age-adjusted Charlson comorbidity index, infection history, antibiotic de-labelling (≥1 AAL removed following AAT) and antibiotic usage for 12 months prior to testing (pre-AAT) and 12 months following testing (post-AAT) were recorded for each patient. Results From the follow-up survey of 112 patients post-AAT, 95.2% (59/62) of patients with complete AAL removal expressed willingness to use ‘de-labelled’ antibiotics and 91.9% (57/62) were adherent to allergy label modification. Comparing antibiotic utilization 12 months pre-AAT versus 12 months post-AAT, AAT was associated with a significant increase in preferred antibiotic therapy [adjusted odds ratio (aOR) 3.29, 95% CI 1.56–6.92] and reduction in restricted antibiotic utilization (aOR 0.42, 95% CI 0.19–0.93). Conclusions An antimicrobial stewardship (AMS)-led AAT programme was safe and effective in the long term in the promotion of preferred and narrow-spectrum antibiotic usage, and favourable patient perception towards the AAT testing results was identified. This study further supports the routine incorporation of AAT into AMS programmes, confirming safety and durability of testing impacts on patients as well as increasing preferred antibiotic utilization.

Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns

“…Assessment in a specialist antibiotic allergy clinic with access to penicillin allergy skin testing and observed oral penicillin challenges (drug provocation tests) is a widely-used approach; there is extensive evidence that this is safe and that the majority of patients assessed will tolerate penicillin antibiotics (that is, they are not allergic and can be de-labeled) (3,(12)(13)(14)(15). Antibiotic allergy assessment and de-labeling meant 59/62 (95.2%) patients were willing to use the de-labeled antibiotic (16). However, prescribers must also be willing to prescribe the relevant antibiotic and, in some settings, the persistence of PALs despite negative observed oral penicillin challenges has been identified as a significant issue (17)(18)(19).…”