Quality of penicillin allergy management in the intensive care unit and internal medicine ward

Background

Penicillin allergy is reported by 10% of the population [1]. The associated morbidity is substantial given its medical and economic implications [2–4]. The aim of this study was to assess the quality of care with regards to the management of penicillin allergy in a university affiliated general hospital with no allergy service.

Material and methods

All admissions from December 1^st 2008 to December 1^st 2009 were hand reviewed for a notion of penicillin allergy. Files were then assessed for (1) quality of allergic history to penicillin, (2) referral to an allergy clinic upon discharge, (3) indications for such a referral, (4) indication for a beta-lactam, and in the latter case, (5) management of antibiotic therapy.

Results

Of the 1738 files reviewed, 172 contained a notion of alleged penicillin allergy. History of the reaction to penicillin was poorly detailed even when patients required beta-lactam therapy (table 1). In the 87 patients who did require a beta-lactam, half received it without any skin testing, challenge or desensitization. No adverse reaction occurred. The main antibiotics used in the remaining patients were fluoroquinolones and vancomycin. Decision-making concerning the choice of antibiotic was documented in only 18%. Upon discharge, only two patients were referred to an allergy clinic for elective penicillin skin testing, even though referral was strongly indicated in 97 patients (table 2).

Table 1 Details included in allergy history

Table 2 Strong arguments for allergy referral.

Conclusion

Penicillin allergy is a frequent problem in hospital practice. Its management is not optimal in most cases. This study stresses the importance of continuous medical education on this subject and the importance of a readily available inpatient allergy service to support hospital practitioners.