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

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Background

Penicillin allergy is reported by 10% of the population [1]. The associated morbidity is substantial given its medical and economic implications [24]. 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 1st 2008 to December 1st 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.

References

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    Solensky R: Hypersensitivity reactions to beta-lactam antibiotics. Clin Rev Allergy Immunol. 2003, 24: 201-20. 10.1385/CRIAI:24:3:201.

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    Lee CE: The incidence of antimicrobial allergies in hospitalized patients: implications regarding prescribing patterns and emerging bacterial resistance. Arch Intern Med. 2000, 160: 2819-22. 10.1001/archinte.160.18.2819.

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    MacLaughlin EJ, Saseen JJ, Malone DC: Costs of beta-lactam allergies: selection and costs of antibiotics for patients with a reported beta-lactam allergy. Arch Fam Med. 2000, 9: 722-6. 10.1001/archfami.9.8.722.

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    Martinez LA: Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med. 2003, 163: 1905-12. 10.1001/archinte.163.16.1905.

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Author information

Correspondence to Philippe Bégin or Matthieu Picard.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Intensive Care Unit
  • Penicillin
  • Vancomycin
  • Skin Testing
  • Continuous Medical Education