Use of a Penicillin Allergy Screening Algorithm and Penicillin Skin Testing for Transitioning Hospitalized Patients to First-Line Antibiotic Therapy

Department

Allergy and Immunology

Document Type

Article

Publication Title

The Journal Of Allergy And Clinical Immunology. In Practice

Abstract

BACKGROUND: Penicillin allergy is the most commonly reported antibiotic allergy. Avoidance of β-lactam antibiotics in hospitalized patients leads to the use of second-line therapies. OBJECTIVE: The utility of a penicillin allergy history algorithm (PAHA) and subsequent penicillin skin testing (PST) in transitioning hospitalized patients from second- to first-line antibiotic therapy is described. METHODS: Through an electronic medical record report, pharmacists identified adult inpatients with penicillin allergy receiving moxifloxacin, intravenous vancomycin, aztreonam, daptomycin, or linezolid, in which a β-lactam antibiotic was preferred. The PAHA was administered to identify patients for PST. Skin-test negative patients were transitioned to first-line β-lactam antibiotic therapy. RESULTS: Fifty patients consented to the study. Historical reactions included hives (16 patients, 32%), angioedema (15, 30%), anaphylaxis (6, 12%), unknown (6, 12%), rash (6, 12%), and dyspnea (1, 2%). Pre-PST antibiotic regimens included vancomycin (82%), aztreonam (22%), moxifloxacin (6%), daptomycin (4%), and/or linezolid (2%). Forty-seven patients (94%) were skin-test negative and were subsequently transitioned to a β-lactam antibiotic. Two patients were skin-test positive and one was histamine nonreactive. No patients experienced an immediate adverse reaction when challenged with a penicillin-based antibiotic. A total of 982 days of second-line antibiotic therapy and at least 23 hospital days to administer the antibiotic were avoided. CONCLUSIONS: The use of the PAHA and subsequent PST is a safe, effective multidisciplinary intervention that facilitates the transition to β-lactam antibiotics. Our approach is unique in that it prioritizes patients based on the use of second-line antibiotics, and then applies an algorithm to determine eligibility for PST.

First Page

1349

Last Page

1355

DOI

10.1016/j.jaip.2017.11.012

Volume

6

Issue

4

Publication Date

7-1-2018

Medical Subject Headings

Adult; Algorithms; Anaphylaxis; Angioedema; Anti-Bacterial Agents (adverse effects); Drug Hypersensitivity (diagnosis); Drug Substitution; Electronic Health Records; Female; Humans; Male; Mass Screening; Medical History Taking (methods, standards); Penicillins (adverse effects, therapeutic use); Prospective Studies; Skin Tests (methods); Urticaria; beta-Lactams (adverse effects, therapeutic use)

PubMed ID

29242142

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