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Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns

Unverified penicillin allergies are common but most patients with a penicillin allergy label can safely use penicillin antibiotics. Penicillin allergy labels are associated with poor clinical outcomes and overuse of second-line antibiotics. There is increasing focus on penicillin allergy “de-labelin...

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Autores principales: Hills, Thomas, Arroll, Nicola, Duffy, Eamon, Capstick, Janice, Jordan, Anthony, Fitzharris, Penny
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8974713/
https://www.ncbi.nlm.nih.gov/pubmed/35386932
http://dx.doi.org/10.3389/falgy.2020.586301
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author Hills, Thomas
Arroll, Nicola
Duffy, Eamon
Capstick, Janice
Jordan, Anthony
Fitzharris, Penny
author_facet Hills, Thomas
Arroll, Nicola
Duffy, Eamon
Capstick, Janice
Jordan, Anthony
Fitzharris, Penny
author_sort Hills, Thomas
collection PubMed
description Unverified penicillin allergies are common but most patients with a penicillin allergy label can safely use penicillin antibiotics. Penicillin allergy labels are associated with poor clinical outcomes and overuse of second-line antibiotics. There is increasing focus on penicillin allergy “de-labeling” as a tool to improve antibiotic prescribing and antimicrobial stewardship. The effect of outpatient penicillin allergy de-labeling on long-term antibiotic use is uncertain. We performed a retrospective pre- and post- study of antibiotic dispensing patterns, from an electronic dispensing data repository, in patients undergoing penicillin allergy assessment at Auckland City Hospital, New Zealand. Over a mean follow-up of 4.55 years, 215/304 (70.7%) of de-labeled patients were dispensed a penicillin antibiotic. Rates of penicillin antibiotic dispensing were 0.24 (0.18–0.30) penicillin courses per year before de-labeling and 0.80 (0.67–0.93) following de-labeling with a reduction in total antibiotic use from 2.30 (2.06–2.54) to 1.79 (1.59–1.99) antibiotic courses per year. In de-labeled patients, the proportion of antibiotic courses that were penicillin antibiotics increased from 12.81 to 39.62%. Rates of macrolide, cephalosporin, trimethoprim/co-trimoxazole, fluoroquinolone, “other” non-penicillin antibiotic use, and broad-spectrum antibiotic use were all lower following de-labeling. Further, antibiotic costs were lower following de-labeling. In this study, penicillin allergy de-labeling was associated with significant changes in antibiotic dispensing patterns.
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spelling pubmed-89747132022-04-05 Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns Hills, Thomas Arroll, Nicola Duffy, Eamon Capstick, Janice Jordan, Anthony Fitzharris, Penny Front Allergy Allergy Unverified penicillin allergies are common but most patients with a penicillin allergy label can safely use penicillin antibiotics. Penicillin allergy labels are associated with poor clinical outcomes and overuse of second-line antibiotics. There is increasing focus on penicillin allergy “de-labeling” as a tool to improve antibiotic prescribing and antimicrobial stewardship. The effect of outpatient penicillin allergy de-labeling on long-term antibiotic use is uncertain. We performed a retrospective pre- and post- study of antibiotic dispensing patterns, from an electronic dispensing data repository, in patients undergoing penicillin allergy assessment at Auckland City Hospital, New Zealand. Over a mean follow-up of 4.55 years, 215/304 (70.7%) of de-labeled patients were dispensed a penicillin antibiotic. Rates of penicillin antibiotic dispensing were 0.24 (0.18–0.30) penicillin courses per year before de-labeling and 0.80 (0.67–0.93) following de-labeling with a reduction in total antibiotic use from 2.30 (2.06–2.54) to 1.79 (1.59–1.99) antibiotic courses per year. In de-labeled patients, the proportion of antibiotic courses that were penicillin antibiotics increased from 12.81 to 39.62%. Rates of macrolide, cephalosporin, trimethoprim/co-trimoxazole, fluoroquinolone, “other” non-penicillin antibiotic use, and broad-spectrum antibiotic use were all lower following de-labeling. Further, antibiotic costs were lower following de-labeling. In this study, penicillin allergy de-labeling was associated with significant changes in antibiotic dispensing patterns. Frontiers Media S.A. 2020-12-16 /pmc/articles/PMC8974713/ /pubmed/35386932 http://dx.doi.org/10.3389/falgy.2020.586301 Text en Copyright © 2020 Hills, Arroll, Duffy, Capstick, Jordan and Fitzharris. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Allergy
Hills, Thomas
Arroll, Nicola
Duffy, Eamon
Capstick, Janice
Jordan, Anthony
Fitzharris, Penny
Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns
title Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns
title_full Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns
title_fullStr Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns
title_full_unstemmed Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns
title_short Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns
title_sort penicillin allergy de-labeling results in significant changes in outpatient antibiotic prescribing patterns
topic Allergy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8974713/
https://www.ncbi.nlm.nih.gov/pubmed/35386932
http://dx.doi.org/10.3389/falgy.2020.586301
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