Antibiotic Awareness Week 2019: A focus on antibiotic allergies
The SHS-UHN Antimicrobial Stewardship Program is committed to getting patients the right antibiotics, when they need them. A big part of this mission is ensuring patients receive the preferred antimicrobial for prophylaxis during surgery or when they have or may have an infection. Much of the time, the preferred therapy are beta-lactam antibiotics such as penicillins or cephalosporins.
Allergy labels that are incomplete or inaccurate can result in lower rates of preferred antimicrobial use, increased costs, length of stay and potentially harm to patients though higher rates of adverse drug reactions or C.difficile infection.
At UHN 15% of our inpatients have a penicillin allergy label in EPR. Very few of these labels have any reaction information and fewer still include all the components required for a decision to made about the safety of preferred antimicrobial therapy.
We know that only 10% of all patients reporting penicillin allergy have a likely penicillin allergy.
Even in the minority of patients with a true type I hypersensitivity reaction (i.e. anaphyaxis, hives), the majority can potentially safely receive cephalosporins with side chains different from that of the drug to which they reacted.
In order get patients the preferred antibiotics, we need better allergy information to support what drug caused the reaction, what type of reaction occurred, when it occurred and if they have tolerated other antibiotics in the past after the initial reaction. With this information, better decisions can be made to ensure patients get the right antibiotics every time.
Evaluation and Management of Penicillin Allergy (including Toolkit for Risk Stratification)
Cephalosporin Cross Reactivity in Penicillin Allergy
Picard M, Robitaille G, Karam F, Daigle J et al, Cross-Reactivity to Cephalosporins and Carbapenems in Penicillin-Allergic Patients: Two Systematic Reviews and Meta-analyses. J Allergy Clin Immunol Pract 2019;7:2722-38
Patient-level Penicillin Allergy Information