Penicillin allergies: referral and management practices of anesthesiologists
© Jain et al; licensee BioMed Central Ltd. 2014
Published: 18 December 2014
Penicillin and other beta-lactams are the most commonly used antibiotics due to their narrow spectrum of activity, low cost and safety profile. However, an “allergy” to Penicillin is also the most commonly reported allergy. Approximately, 5-10% of all patients self-report an allergy to Penicillin and of these <10% are found to have true IgE mediated allergy on skin testing.
Numerous studies have confirmed the usefulness and strong negative predictive value (>99%) of skin testing to rule out true IgE mediated Penicillin allergy. Less than 10% of patients with a history of penicillin allergy are found to be actually allergic to penicillin on skin testing. Despite this, most physicians forgo further investigations in favor of the usage of alternative antibiotics.
A questionnaire was designed to evaluate the referral practices of Anesthesiologists for a presumed Penicillin allergy.
The preliminary study was administered as a semi-structured interview to Anesthesiology Staff Physicians and Senior Residents at Memorial University of Newfoundland. The responses were analyzed using recursive abstraction
89.5% of respondents have never referred patients for evaluation of drug allergy, although, an equal number felt a referral would be helpful. However, 47.3% said they have verbally communicated to their patients that they should speak to their Family Doctor for work up of their allergy. 21.1% of participants felt time constraint was a barrier to creating a referral; another 15.8% felt that this was the responsibility of another physician (Surgeon or Family Doctor). An additional 26.3% did not comment on barriers but stated they would just give an alternative medication rather than refer. Another 15.8% mentioned that surgery is generally imminent and would not delay surgery to a referral. All participants stated they would choose an alternative antibiotic in the case of a history of penicillin allergy.
Carrying a presumed diagnosis of penicillin ‘‘allergy’’ has significant consequences on the health care system and patient outcome. Anesthesiologists in our study do inquire about specifics of allergy history, however, the referrals are virtually non-existent. As a result, anesthesiologists are prescribing more expensive antibiotics, which have higher potential for emergence of antibiotic resistance. Our future plans are to complete data collection at other centers and to develop an intervention to improve referral practices and study its impact.
- Lee AU: The incidence of antimicrobial allergies in hospitalized patients: implications regarding prescribing patterns and emerging bacterial resistance. Arch Intern Med. 2000, 160 (18): 2819-10.1001/archinte.160.18.2819.View ArticlePubMedGoogle Scholar
- Gadde J, Spence M, Wheeler B: “Clinical experience with penicillin skin testing in a large inner-city STD clinic”. JAMA. 1993, 270: 2456-63. 10.1001/jama.1993.03510200062033.View ArticlePubMedGoogle Scholar
- Macy Eric, Richard Contreras: "Health Care Use and Serious Infection Prevalence Associated with Penicillin “allergy” in Hospitalized Patients: A cohort Study.". Journal of Allergy and Clinical Immunology. 2013Google Scholar
- Phillips Elizabeth: "Cost-effectiveness Analysis of Six Strategies for Cardiovascular Surgery Prophylaxis in Patients Labeled Penicillin Allergic.". Am. J. of Health-Systems Pharm. 2000, 57: 339-Google Scholar
- Picard Matthieu, Philippe Bégin: "Treatment of Patients with a History of Penicillin Allergy in a Large Tertiary-Care Academic Hospital.". The Journal of Allergy and Clinical Immunology. 2013, 252-57. Practice 1.3Google Scholar
- Sade K, Holtzer I, Levo Y: "The Economic Burden of Antibiotic Treatment of Penicillin-allergic Patients in Internal Medicine Wards of a General Tertiary Care Hospital.". Clinical Experimental Allergy. 2003, 33 (4): 501-06. 10.1046/j.1365-2222.2003.01638.x.View ArticlePubMedGoogle Scholar
- Warrington , Silviu-Dan : Allergy, Asthma & Clinical Immunology. 2011, 7 (Suppl 1): S10-10.1186/1710-1492-7-S1-S10.View ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.