Penicillin allergy delabeling

Samarakoon, Upeka; Accarino, John; Wurcel, Alysse G.; Jaggers, Jordon; Judd, Allen; Blumenthal, Kimberly G.

doi:10.1016/j.anai.2022.12.023

Cited by 15 publications

(11 citation statements)

References 114 publications

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“…In many cases, a thorough patient history with comprehensive medication allergy review can uncover information that leads to penicillin allergy delabeling. 10 When feasible, skin testing or an antibiotic dose challenge (either as a single dose or as graded dosing) may be performed in advance of surgical procedures and can assist in allergy delabeling or identify the safest alternative antibiotic choice. Once the legitimacy of the allergy and reaction are adjudicated, the use of a prescribing algorithm or cross-reactivity chart can improve appropriate prescribing of beta-lactams.…”

Section: Discussionmentioning

confidence: 99%

Debilitating Gentamicin Ototoxicity: Case Report and Recommendations Against Routine Use in Surgical Prophylaxis

Kalmanson

McLoughlin

Kiser

et al. 2023

Ann Otol Rhinol Laryngol

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Introduction: Aminoglycoside antibiotics such as gentamicin are bactericidal and effective against gram negative organisms and act synergistically against gram positive organisms, including S taphylococcus aureus. However, they have serious adverse effects such as nephrotoxicity and ototoxicity. Gentamicin ototoxicity may occur after a single dose and results in decreased vestibular function, which is frequently debilitating and often permanent. Objective: To emphasize the risk of gentamicin ototoxicity and suggest alternative antibiotics in penicillin-allergic patients undergoing surgery. Case Summary: We present a case of a woman with preexisting Meniere’s Disease who received gentamicin 400 mg perioperatively for a sigmoidectomy due to a penicillin allergy listed in the patient’s medical record. The patient developed severe ototoxicity preventing her from working or driving. Physical examination was remarkable for a broad-based gait requiring assistance to walk and bilateral corrective saccades. Vestibular testing revealed high-grade bilateral vestibular loss associated with all semicircular canals, a considerable decline compared to her function 3 years prior. Discussion: Gentamicin is indicated for surgical prophylaxis when a patient has a true allergy to penicillins and cannot receive cephalosporins, though alternatives exist. True allergies include IgE-mediated illness (anaphylaxis, bronchospasm, or urticaria 30-60 minutes after administration) or exfoliative reactions (Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis). The authors encourage more prudent use of gentamicin, especially in patients susceptible for debilitating otologic insults, and offer recommendations for alternative agents prior to using gentamicin.

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Section: Discussionmentioning

confidence: 99%

Debilitating Gentamicin Ototoxicity: Case Report and Recommendations Against Routine Use in Surgical Prophylaxis

Kalmanson

McLoughlin

Kiser

et al. 2023

Ann Otol Rhinol Laryngol

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“…[17][18][19] The PCN allergy delabeling by either a provider or a pharmacist following a review of the history of allergic reaction is being recognized and implemented as a stewardship initiative to improve antimicrobial prescribing practices. 20,21 The authors identified that this study has 2 limitations. The contents of the patient charts used for our data analysis were not initially intended for research purposes, and therefore may contain inaccurate or missing information.…”

Section: Discussionmentioning

confidence: 99%

“…17-19 The PCN allergy delabeling by either a provider or a pharmacist following a review of the history of allergic reaction is being recognized and implemented as a stewardship initiative to improve antimicrobial prescribing practices. 20,21…”

Section: Discussionmentioning

confidence: 99%

Azithromycin Prescriptions in Children From 2016-2018: Room for Improvement

Petrone,

Whiteman,

Gupta

2023

Clin Pediatr (Phila)

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Azithromycin was the second-most prescribed antibiotic agent in the United States with 27.6 million prescriptions in 2020. 1 Azithromycin is a macrolide class, broadspectrum antibiotic that was known to have activity against both gram-positive and gram-negative organisms including, but not limited to, Haemophilus influenzae, Moraxella catarrhalis, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Streptococcus pneumoniae. 1,2 However, we have come to learn with recent studies that there is increasing resistance due to overuse. 3,4 Azithromycin has been commonly used in pediatric practice due to its broad spectrum, few side effects, and short treatment duration. 5 In 2020, the Centers for Disease Control Prevention reported a national average of 613 antibiotic prescriptions per 1000 persons. 1 West Virginia had the highest number of outpatient antimicrobial prescriptions from 2017 to 2020, with an overall outpatient prescription rate of 974 per 1000 persons in 2020. 1,[6][7][8] These data, combined with the prevalence of 21% to 33.5% of children receiving suboptimal antibiotic therapy in the outpatient setting, highlight the need for stewardship interventions among the pediatric populations in the state of West Virginia. 8,9

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“…The benefits of antibiotic allergy delabelling is best exemplified with beta-lactam (in particular penicillin) allergy, which is often incorrectly and over-diagnosed ( 6 – 9 ). There has been much interest in programs to delabel suspected penicillin allergy both in adults and children, in particular in antimicrobial stewardship programs to prevent widespread use of alternative broad spectrum non-penicillin antibiotics which may lead to antimicrobial resistance and use of agents that may not be as effective as penicillins ( 10 – 13 ). Clinical pharmacist and nurse-led allergist supervised delabelling programs for low-risk index reactors have been shown to be safe, effective and potentially scalable ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Delabelling multiple antibiotic allergy: Practical issues

Thong

2023

Front. Allergy

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With the growing incidence of multi-drug resistant organisms, delabelling incorrect antibiotic allergies has become an integral part of antimicrobial stewardship worldwide. For example, around 90% of penicillin allergy labels are found to be inaccurate following a full allergy work-up, which deprive patients the use of effective first-line penicillin antibiotics and increase the risk of antimicrobial resistance with the use of other extended spectrum non-penicillin antimicrobials. Significant numbers of adult and paediatric patients over time are labelled with multiple penicillin and non-penicillin antibiotic allergies often during inappropriate antimicrobial use, resulting in a label of “multiple antibiotic allergy”. In contrast to delabelling penicillin allergy where oral direct provocation tests can be used for low-risk, mild reactions, and sensitivity/specificity/positive and negative predictive values of skin tests have been demonstrated, diagnostic tests for multiple antibiotic allergy often require the use of a combination of in-vivo and in-vitro tests across different antimicrobial classes for evaluation. Shared decision making with patients and informed consent are also needed when prioritising which drugs to delabel first, balancing the risks, benefits of testing vs. interim use of alternative antibiotics. Similar to delabelling penicillin allergy, the cost-effectiveness of delabelling multiple drug allergies is unknown.

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Penicillin allergy delabeling

Cited by 15 publications

References 114 publications

Debilitating Gentamicin Ototoxicity: Case Report and Recommendations Against Routine Use in Surgical Prophylaxis

Debilitating Gentamicin Ototoxicity: Case Report and Recommendations Against Routine Use in Surgical Prophylaxis

Azithromycin Prescriptions in Children From 2016-2018: Room for Improvement

Delabelling multiple antibiotic allergy: Practical issues

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