Inglis Joshua M, Caughey Gillian E, Smith William, Shakib Sepehr
Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Intern Med J. 2017 Nov;47(11):1292-1297. doi: 10.1111/imj.13558.
The majority of patients with penicillin allergy labels tolerate penicillins. Inappropriate avoidance of penicillin is associated with increased hospitalisation, infections and healthcare costs.
To examine the documentation of penicillin adverse drug reactions (ADR) in a large-scale hospital-based electronic health record.
Penicillin ADR were extracted from 96 708 patient records in the Enterprise Patient Administration System in South Australia. Expert criteria were used to determine consistency of ADR entry and suitability for further evaluation.
Of 43 011 unique ADR reports, there were 5023 ADR to penicillins with most being entered as allergy (n = 4773, 95.0%) rather than intolerance (n = 250, 5.0%). A significant proportion did not include a reaction description (n = 1052, 20.9%). Using pre-set criteria, 10.1% of reports entered as allergy had a reaction description that was consistent with intolerance and 31.0% of the entered intolerances had descriptions consistent with allergy. Virtually all ADR (n = 4979, 99.1%) were appropriate for further evaluation by history taking or immunological testing and half (50.7%, n = 2549) had documented reactions suggesting low-risk of penicillin allergy.
The frequency of penicillin allergy label in this data set is consistent with the known overdiagnosis of penicillin allergy in the hospital population. ADR documentation was poor with incomplete entries and inconsistent categorisation. The concepts of allergy and intolerance for ADR classification, whilst mechanistically valid, may not be useful at the point of ADR entry by generalist clinicians. Systematic evaluation of reported ADR is needed to improve the quality of information for future prescribers.
大多数有青霉素过敏标签的患者能够耐受青霉素。不恰当地避免使用青霉素与住院率增加、感染及医疗费用上升有关。
在一个大型的基于医院的电子健康记录中检查青霉素药物不良反应（ADR）的记录情况。
从南澳大利亚企业患者管理系统中的96708份患者记录中提取青霉素ADR。采用专家标准来确定ADR录入的一致性以及是否适合进一步评估。
在43011份独特的ADR报告中，有5023份是青霉素ADR，其中大多数被记录为过敏（n = 4773，95.0%）而非不耐受（n = 250，5.0%）。很大一部分报告未包含反应描述（n = 1052，20.9%）。根据预设标准，记录为过敏的报告中有10.1%的反应描述与不耐受一致，而记录的不耐受中有31.0%的描述与过敏一致。几乎所有的ADR（n = 4979，99.1%）都适合通过病史采集或免疫检测进行进一步评估，且一半（50.7%，n = 2549）有记录的反应提示青霉素过敏风险较低。
该数据集中青霉素过敏标签的频率与医院人群中已知的青霉素过敏过度诊断情况一致。ADR记录不佳，存在录入不完整和分类不一致的问题。ADR分类中过敏和不耐受的概念，虽然在机制上是合理的，但对于普通临床医生在录入ADR时可能并无帮助。需要对报告的ADR进行系统评估，以提高未来开处方者的信息质量。
