Category: Professional Posters
Purpose: Penicillin allergy is the most commonly reported beta-lactam allergy. True, IgE-mediated penicillin allergies are rare with the estimated frequency of anaphylaxis being less than 0.05% in the general population. The high prevalence of reported penicillin allergies may be attributed to inaccurate allergy documentation. Beta-lactam antibiotics, including cephalosporins, are commonly avoided in patients who report a penicillin allergy, despite recent evidence demonstrating minimal cross-reactivity. The purpose of this study was to evaluate the impact of a pharmacy-driven allergy assessment on decreasing the use of non-beta-lactam alternatives and improving allergy documentation in patients with a reported penicillin allergy.
Methods: This single-center, IRB-approved, prospective study evaluated patients admitted to Baptist Hospital of Miami with a reported penicillin allergy between February 6, 2019 and April 30, 2019. Patients admitted with a documented penicillin allergy who met inclusion criteria were interviewed to clarify allergy history (i.e. severity, reaction) in order to improve allergy documentation and optimize antibiotic selection. Medication records and outpatient fill history were evaluated for prior tolerance of beta-lactam antibiotics. For patients with mild-to-moderate penicillin allergies and/or patients with prior tolerance of beta-lactam antibiotics (regardless of severity), treatment with a beta-lactam antibiotic was recommended to the prescriber. The primary endpoint was the number of patients with a reported penicillin allergy for whom the assessment led to treatment with a beta-lactam antibiotic. Secondary outcomes included cost of therapy of antibiotic recommended by pharmacist compared to the agent(s) initially selected by the prescriber, prescribing trends before and after the allergy assessment and adverse events. Descriptive statistics and percentages were analyzed and reported using Microsoft Excel.
Results: A total of 63 patients met inclusion criteria. Of these, 43 patients (68%) were switched from a non-beta-lactam antibiotic to a beta-lactam antibiotic with a 100% prescriber acceptance rate. Aztreonam and levofloxacin were the most commonly prescribed non-beta-lactam antibiotics prior to the allergy assessment. Prior beta-lactam use was confirmed in 57% of patients and allergy documentation was updated in 83% of patients. A potential cost savings of $21,468 was estimated over a 3-month period.
Conclusion: Conducting a pharmacy-driven allergy assessment led to improved allergy documentation, increased use of beta-lactam antibiotics and associated cost savings for patients with a reported penicillin allergy.