Category: Professional Posters
Purpose: Penicillin allergies are reported by 10-15% of patients, making it the most commonly reported drug allergy in the United States. Most allergies are self-reported and unconfirmed by a medical professional. True penicillin allergies are rare. Compared to penicillin non-allergic patients, those reporting a penicillin allergy have increased exposure to broad-spectrum antibiotics and higher rates of multidrug resistant infections. Selecting an alternative antibiotic may also provide less effective treatment for specific infections and increase antibiotic resistance. Penicillin allergy skin testing (PST) can be used to rule out true penicillin allergies and allow those deemed non-allergic to be treated with penicillin antibiotics.
Methods: Penicillin allergy skin testing (PST) was implemented at FirstHealth of the Carolinas Moore Regional Hospital in May 2017 as an antimicrobial stewardship initiative. Moore Regional Hospital is a 400-bed acute care, not-for-profit community hospital in Pinehurst, NC. A PST protocol and order set were created and incorporated into the hospital’s electronic medical record system. Infection control nursing staff and clinical pharmacists received both online and live training prior to implementation. PST can be ordered by any prescribing practitioner at FirstHealth. After an order is placed and prior to testing, the antimicrobial stewardship (AMS) pharmacist must review the patient’s profile and interview the patient to ensure eligibility. The patient must provide verbal consent. When eligibility is confirmed, a testing kit is prepared by the inpatient pharmacy. Testing is performed by a trained infection control nurse and the AMS pharmacist and is completed in a two-step process: a skin prick test followed by an intradermal test. If the patient tests negative, they are deemed to be penicillin non-allergic. Physicians have the ability to order an optional oral challenge or can transition to an intravenous (IV) penicillin product. The AMS pharmacist updates the patient’s allergy information and provides the patient with a test result card.
Results: Between May 2017 and June 2019, 13 penicillin allergy tests were performed. Eleven tests were performed on patients currently receiving antibiotic therapy and two tests were performed during the training process. All 13 patients tested were deemed to be penicillin non-allergic. Of the 11 patients receiving current antibiotic therapy, 10 had changes made to their antibiotic regimens based on PST results. Four of 10 patients were changed to a first-line antibiotic regimen, four of 10 were changed to a more narrow antibiotic therapy, and the remaining two of 10 were transitioned to oral therapy from IV therapy.
Conclusion: Penicillin allergy skin testing is an effective tool for confirmation of penicillin allergies. All patients who received PST at FirstHealth were confirmed to be penicillin non-allergic. Ten of 11 PST patients currently on antibiotic therapy were transitioned to more targeted antibiotic regimens. Therefore, PST is an effective antimicrobial stewardship tool that can help reduce inappropriate antibiotic use, decrease antibiotic resistance, and provide the most efficacious treatment for specific disease states.