PURPOSE OF THE STUDY.
To assess the impact of a diagnosis of penicillin allergy in hospitalized patients.
The study included all patients (children and adults) admitted at the University Medical Center in Utrecht, the Netherlands, over a 1-year period who underwent a standardized pharmacotherapeutic interview. There were 997 patients with documentation of penicillin allergy (Pen-A) and 2939 patients without documentation of penicillin allergy (non–Pen-A).
This was a prospective, matched cohort study. Patients were registered as having penicillin allergy if the history demonstrated either an evaluation by a specialist or general practitioner and/or symptoms of cutaneous, respiratory, or cardiovascular disturbance or fever. The primary outcome measure was the prevalence of Pen-A registration. Secondary outcomes included the risk of receiving a reserve antibiotic, the risk of death during hospitalization, the duration of hospitalization, and the risk of readmission within 4 and 12 weeks after discharge.
Of hospitalized patients, 5.6% had a Pen-A registration. Compared with non–Pen-A control patients, Pen-A subjects had a significantly higher rate of receiving a broad-spectrum antibiotic (relative risk, 1.38; 95% confidence interval, 1.22–1.56), of receiving 2 or more antibiotics (21.7% vs 16.9%), and of readmission within 12 weeks after discharge (relative risk, 1.28; 95% confidence interval, 1.10–1.49). There was no significant difference between the two groups in terms of duration of hospitalization, mortality during hospitalization, and risk of readmission within 4 weeks of discharge. Of interest, 14.5% of all Pen-A patients treated with antibiotics were exposed to penicillin during the hospitalization.
Pen-A registration in the hospital setting has a high impact on antibiotic treatment strategies, including the prescription of broad-spectrum antibiotics and multiple antibiotics as well as an increased risk of readmission within 12 weeks after discharge.
The prevalence of penicillin allergy diagnosis in this hospitalized cohort was 5.6%, which is significantly lower than the reported prevalence of 11% to 15% in other studies conducted in the United States. This difference is likely due to the rigorous standardized interview used in this study. All too often, a report of penicillin allergy by the patient is recorded without attempts to verify the diagnosis or perform diagnostic skin testing. Given the negative impact of such a diagnosis on medical outcomes, it is incumbent upon the general practitioner and specialist alike to pursue a detailed history of the adverse event and to obtain diagnostic testing when indicated. This approach is now one of the recommended interventions issued by the American Academy of Allergy, Asthma, and Immunology as part of the “Choosing Wisely” campaign.
- Copyright © 2017 by the American Academy of Pediatrics