Hearsey, D., Elkhalifa, S., Sandoe, J. orcid.org/0000-0003-0193-8677 et al. (7 more authors) (Cover date: October 2023) Removal of incorrect penicillin allergy labels in a UK hospital. Clinical Microbiology and Infection, 29 (10). P1338.E1-1338.E4. ISSN 1198-743X
Abstract
Objectives:
Penicillin allergy records are common, often incorrect and are associated with broad spectrum antibiotic use. We piloted a pharmacist-led multidisciplinary penicillin allergy de-labelling daily ward round to determine the opportunity for penicillin allergy de-labelling in a UK hospital.
Methods:
A daily ward round, delivered by antibiotic pharmacists or junior doctors, identified adult medical and surgical patients between 7 November 2022 and 31 January 2023 with a penicillin allergy record that was preventing first-line penicillin use. An allergy history was taken before risk stratifying likelihood of future harm from penicillin re-exposure and an allergy testing method was determined (direct de-label on history alone or after direct drug provocation testing). After successful allergy de-label, the antibiotic was switched to a penicillin antibiotic.
Results:
Of 7214 inpatients during the study period, 1133 (15.7%) had a penicillin allergy record. Of 285 allergy histories taken, 105 (36.8%) met high-risk criteria, 45 (15.8%) met low-risk criteria eligible for direct de-label and 73 (25.6%) met criteria eligible for direct drug provocation testing. We were unable to obtain a history for 61 (21.4%) patients. Of 45 low-risk patients eligible for direct de-label, 40 (88.9%) were de-labelled of whom 24 (53.3%) were switched to a penicillin antibiotic. Of 73 patients with a low-risk allergy history eligible for direct drug provocation testing, 16 (21.9%) received direct drug provocation testing, of whom 9 were switched to a penicillin antibiotic. Two direct de-label patients experienced harm (thrush within 5 days and delayed skin reaction after day 5); none of the direct drug provocation testing patients had a reaction by day 5. The switches resulted in reduced alternative antibiotic use by 173 Daily Defined Doses (DDDs).
Discussion:
Penicillin allergy de-labelling patient pathway delivered by pharmacists and junior doctors was safe and effective and well accepted by patients and the wider clinical teams.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2023, Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.This is an author produced version of an article published in Clinical Microbiology and Infection. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Allergy; Antimicrobial stewardship; De-labelling; PADL; Penicillin; Penicillin allergy; Penicillin allergy de-labelling |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Medical Research (LIMR) > Division of Gastroenterology and Surgery |
Depositing User: | Symplectic Publications |
Date Deposited: | 09 Oct 2023 11:37 |
Last Modified: | 21 Jun 2024 00:13 |
Published Version: | https://www.clinicalmicrobiologyandinfection.com/a... |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.cmi.2023.06.024 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:202242 |
Download
Filename: Clean Copy - RIPAL write up CLM-23-25682.pdf
Licence: CC-BY-NC-ND 4.0