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Changes in Perioperative Antibiotic Use When Utilizing Preoperative Penicillin Allergy Testing For Patients With History of Allergy to Penicillin
Sunday, March 5, 2017: 2:15 PM
Thomas B. Murphy Ballroom 1 (Georgia World Congress Center, Building B)
Keith A. Sacco, M.D., , , , ,
Rationale: Penicillin allergy is the most commonly reported drug-class allergy, but 80-90% of individuals with self-reported penicillin allergy are actually able to tolerate penicillins. We hypothesized that perioperative antibiotic use would be significantly altered by performing penicillin allergy testing as part of the preoperative evaluation (POE) process for patients with a history of penicillin allergy.

Methods: We compared the use of vancomycin, clindamycin, and levofloxacin in two groups of patients with a history of penicillin allergy who were evaluated in our institution’s POE clinic from 2014 to 2015. One group was referred for penicillin allergy testing as part of their POE clinic visit. The other group did not undergo penicillin allergy testing. The primary outcomes were the differences in antibiotic use compared between these two groups.

Results: During the studied time period, 853 (7.5%) patients reported a history of penicillin allergy, and of these, 442 (51.8%) were referred for penicillin allergy testing. Of these 442 patients, 405 (91.6%) had negative penicillin allergy skin tests and were given clearance to receive penicillin or cephalosporin antibiotics. For the group of patients who had reported penicillin allergy and were referred for penicillin allergy testing, the use of vancomycin, clindamycin, and levofloxacin were all significantly reduced (p < .001 χ2 test) by 32%, 19.4%, and 7.5% respectively compared to the group who did not have penicillin allergy testing. 

Conclusions: Incorporating penicillin allergy testing as a component of the preoperative evaluation process reduces the use of vancomycin, clindamycin, and levofloxacin in patients with a history of penicillin allergy.