A 10 Year Cost Comparison of Non-Penicillin Antibiotics to Treat Bacterial Rhinosinusitis, Group a Strep, and Otitis Media Versus Penicillin Skin Testing, Allergy Consultation and Penicillin Antibiotics
Monday, March 5, 2018
South Hall A2 (Convention Center)
Whitney A Blackwell, MD, Miguel A. Park, MD
Rationale: The use of non-penicillin antibiotics to treat bacterial rhinosinusitis, group A strep (GAS), and otitis media has been shown to be associated with bacterial resistance leading to treatment failure and increased costs. We hypothesized that PCN skin testing (PST), allergy consultation, and a PCN prescription would be more cost effective than prescriptions for non-penicillin antibiotics when looking at recurrent infection treatment over 10 years.

Methods: A cohort of 503 PCN allergic patients were identified by a pharmacist from October 2006 to November 2007. This cohort was followed for 10 years to determine which antibiotics were prescribed with note of the diagnosis by review of their medical record. The prices were examined by the cost to the institution. Costs of antibiotics, PST, and allergy consultations were obtained from the Mayo Clinic billing department.

Results: In each disease process, patients were treated with an average of 2.7 prescriptions for sinusitis, 2.07 for otitis media, and 2.54 for GAS. The average cost of allergy consultation, PST, and PCN prescriptions was $125.12 in comparison to non-penicillin prescriptions over the 10 years which was $31.41; Average of $14.60 for sinusitis, $29.18 for otitis media, and $50.45 for GAS. The only patients that benefit from PST and consultation in a direct cost comparison were patients in the GAS subgroup that had received a prescription for erythromycin.

Conclusions: In patients with reported PCN allergy, it is more cost effective to prescribe non-penicillin drugs than to provide allergy consultation and PST for recurrent bacterial rhinosinusitis, group A strep, and otitis media.