Penicillin allergy—getting the label right

Bulletin, Drug and Therapeutics

doi:10.1136/bmj.j3402

Cited by 11 publications

(7 citation statements)

References 26 publications

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“…The prevalence of piperacillin-tazobactam use (8.2%) was above the expected prevalence of P. aeruginosa in unselected outpatients (4%), but in line with the expected prevalence in COPD patients with advanced airflow obstruction (8–13%) [ 26 ]. The prevalence of moxifloxacin use (10.9%) is in line with the prevalence of reported penicillin allergy, but higher than the prevalence of truly allergic patients [ 27 ].…”

Section: Discussionmentioning

confidence: 93%

In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study

et al. 2023

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Background The use of antibiotics in mild to severe acute exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial. Aim To explore in-hospital antibiotic use in severe acute exacerbations of COPD (AECOPD), to analyze determinants of in-hospital antibiotic use, and to investigate its association with hospital length of stay (LOS) and in-hospital mortality. Methods A retrospective, observational study was conducted in Ghent University Hospital. Severe AECOPD were defined as hospitalizations for AECOPD (ICD-10 J44.0 and J44.1) discharged between 2016 and 2021. Patients with a concomitant diagnosis of pneumonia or ‘pure’ asthma were excluded. An alluvial plot was used to describe antibiotic treatment patterns. Logistic regression analyses identified determinants of in-hospital antibiotic use. Cox proportional hazards regression analyses were used to compare time to discharge alive and time to in-hospital death between antibiotic-treated and non-antibiotic-treated AECOPD patients. Results In total, 431 AECOPD patients (mean age 70 years, 63% males) were included. More than two-thirds (68%) of patients were treated with antibiotics, mainly amoxicillin-clavulanic acid. In multivariable analysis, several patient-related variables (age, body mass index (BMI), cancer), treatment-related variables (maintenance azithromycin, theophylline), clinical variables (sputum volume and body temperature) and laboratory results (C-reactive protein (CRP) levels) were associated with in-hospital antibiotic use independent of sputum purulence, neutrophil counts, inhaled corticosteroids and intensive care unit of which CRP level was the strongest determinant. The median hospital LOS was significantly longer in antibiotic-treated patients (6 days [4–10]) compared to non-antibiotic-treated patients (4 days [2–7]) (p < 0.001, Log rank test). This was indicated by a reduced probability of hospital discharge even after adjustment for age, sputum purulence, BMI, in-hospital systemic corticosteroid use and forced expiratory volume in one second (FEV1) (adjusted hazard ratio 0.60; 95% CI 0.43; 0.84). In-hospital antibiotic use was not significantly associated with in-hospital mortality. Conclusions In this observational study in a Belgian tertiary hospital, in-hospital antibiotic use among patients with severe AECOPD was determined by the symptom severity of the exacerbation and the underlying COPD severity as recommended by the guidelines, but also by patient-related variables. Moreover, in-hospital antibiotic use was associated with a longer hospital stay, which may be linked to their disease severity, slower response to treatment or 'harm' due to antibiotics. Trial registration Number: B670201939030; date of registration: March 5, 2019.

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Section: Discussionmentioning

confidence: 93%

In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study

et al. 2023

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“…Penicillin allergy can be a serious and life threatening reaction and reduces the choice of antibiotics available to treat infection with this first-line antibiotic 1. It is reported that 10% of the UK population have a penicillin allergy with approximately one-fifth of these being a true allergy,2 3 and many deemed spurious 4.…”

Section: Introductionmentioning

confidence: 99%

Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts

et al. 2019

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ObjectiveTo investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context.SettingData were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017.DesignCohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report.ParticipantsInpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs.ResultsA total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73) p<0.001). Guideline-adherence for CAP was higher if penicillin allergy (151 of 163; 92.6%) versus no allergy (582 of 810; 71.9%) (OR 0.20 (95% CI 0.10 to 0.37) p<0.001). There was no difference in adherence between those with and without penicillin allergy for UTI, HAP or SSTI treatment.ConclusionsA relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP, received more guideline adherent antibiotics than those without allergy. Future studies investigating the clinical impact of penicillin allergy should include data on adherence to antibiotic guidelines.

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“…Oral provocation tests should be undertaken with medical supervision and involve incremental doses of the antibiotic. 2 Those working in head and neck surgery should keep an eye out for this sign. It is clear that it demonstrates the severity of sepsis, and if encountered should alert the operator to a likely prolonged inpatient stay.…”

Section: Customer Servicementioning

confidence: 99%