Improving Antibiotic Choice in Hospitalized Medical Patients Reporting Penicillin Allergy
Sunday, March 5, 2017: 2:00 PM
Thomas B. Murphy Ballroom 1 (Georgia World Congress Center, Building B)
Kimberly G. Blumenthal, MD, , , , , , ,
Rationale: Reported penicillin allergy rarely reflects penicillin intolerance.  Failure to address inpatient penicillin allergies results in more broad-spectrum antibiotic use, treatment failures, and adverse drug events.  We aimed to determine the optimal approach to penicillin allergies among medical inpatients. 

Methods: We evaluated internal medicine inpatients reporting penicillin allergy in three periods: (1) standard of care (SOC), (2) penicillin skin testing (ST), and (3) computerized guideline application with decision support (APP).  The primary outcome was use of a penicillin or cephalosporin, comparing interventions to SOC using multivariable logistic regression.

Results: There were 625 patients: SOC 148, ST 278, and APP 199.  Of 278 ST patients, 179 (64%) were skin test eligible; 43 (24%) received testing and none were allergic. In the APP period, there were 292 unique website views; 112 users (38%) completed clinical decision support.  While ST period patients did not have an increased odds of penicillin or cephalosporin use overall (aOR 1.3 [95% CI 0.8, 2.0]), we observed a significant increased odds of penicillin or cephalosporin use overall in the APP period (aOR 1.8 [95% CI 1.1, 2.9]), and in a per protocol analysis of the skin tested subset (aOR 5.6 [95% CI 2.5, 12.4]). 

Conclusions: Both the computerized guideline with decision support and penicillin skin testing when completed increased use of penicillin and cephalosporin antibiotics among inpatients reporting penicillin allergy.  While the skin tested subset showed an almost 6-fold impact, the computerized guideline significantly increased penicillin or cephalosporin use overall nearly 2-fold and was readily implemented.