261 The Real Use of Beta-Lactams after "Penicillin Allergic" Label Removal

BACKGROUND: The "penicillin allergic" label becomes very common, thus preventing from many patients the use of one of the most efficient antibiotic drugs, with the lowest cost and toxic effects. However, approximately 80% of patients with a history of penicillin allergy have negative results if they are skin tested and can actually use this drug class. We sought to determine whether in real life, removal of the label is implemented to the treatment of beta-lactams when it is required. METHODS: A retrospective study that includes all penicillin allergy history–positive/penicillin skin test–negative/oral amoxicillin challenge-non reactive individuals who had been tested in advance of need between the years 2000 toi 2009 at one medical center (n = 140). To uncover late reactions, they were offered after the test a 5 day course of amoxicillin. The study tool was a phone-questionnaire assessing the patients' confidence in their test results, and whether they have used penicillin since testing. RESULTS: 106 patients (76%) agreed to participate in the survey. Ninety-nine patients (93%) chose to take the 5 day course of amoxicillin. From this group of patients twenty-seven (27.2%) answered that they feel intermediate insecurity and fourteen (14.1%) that they feel complete insecurity to receive penicillin. Since having the test seventy 2 (72.7%) of the 99 needed penicillin. Sixty-two (86.1%) indeed took a beta-lactam while 10 patients (13.9%) chose to receive another antibiotic class due to their or their physician's disbelief in the test. All the patients (n = 7) who chose not to take the course of amoxicillin after the test stated that they feel complete insecurity to receive penicillin. Four (57.1%) of these patients had a disease that requires a beta-lactam antibiotic and actually, none of them agreed to take one (P = 0.01). CONCLUSIONS: A negative penicillin test done in advance of need even when includes an oral challenge may not be enough to convince patients that they can use beta-lactams. Our study suggests that giving a 5 day course of amoxicillin after the test increases the patients' confidence in the results.