Lots of people think they're allergic to penicillin, but aren't — so when they have infections, doctors are obliged to skip the front-line drugs, which accelerates the pace of antibiotic resistance in common bacteria.
A study in the Journal of Allergy and Clinical Immunology shows that testing for penicillin allergies before deploying second-line antibiotics can result in a six-fold increase in penicillin prescriptions.
But of those 43, skin test results showed that none were allergic to penicillin or similar antibiotics. The results prompted a six-fold increased rate of prescribing penicillin and similar drugs in that group.
The clinical guideline group saw a two-fold improvement in prescriptions. That guideline simply prompted doctors to rethink each patients' allergy and assign him or her into risk categories for having an allergic reaction to a penicillin or similar antibiotic. The risk categories started at "very low risk," which meant doctors could just give them the antibiotic—allergy shmallergy. Low- and medium-risk groups prompted the doctor to test out a low dose of antibiotic or consult with an allergist. And for the highest-risk patients, the doctor just avoided the drugs.
"The interventions implemented challenged the status quo by introducing a new process (i.e., skin testing) and a new technology (i.e., computerized guideline) to change the care of inpatients labeled 'penicillin-allergic,'" the authors concluded. Though hospitals and doctors can be slow to change, they're hopeful that the study offers a few steps forward to improving antibiotic stewardship and patient care.
Tackling Inpatient Penicillin Allergies: Tools for Antimicrobial Stewardship
[Kimberly G. Blumenthal, Paige G. Wickner, Shelley Hurwitz, Nicholas Pricco, Alexandra E. Nee, Karl Laskowski, Erica S. Shenoy and Rochelle P. Walensky/Journal of Allergy and Clinical Immunology]
False penicillin allergies fuel superbugs—and doctors are fighting back
[Beth Mole/Ars Technica]
(Image: Antibiotic sensitvity and resistance, Dr Graham Beards, CC-BY-SA)