Department of Pharmacy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK.
Birmingham Public Health Laboratory, National Infection Service, Public Health England, Birmingham, UK.
Int J Clin Pharm. 2021 Jun;43(3):461-475. doi: 10.1007/s11096-020-01226-7. Epub 2021 Jan 13.
Background A label of penicillin allergy is held by 6-10% of the general population and 15-20% of inpatients. > 90% of these labels are found to be spurious after formal allergy assessment. Carrying an unnecessary label of penicillin allergy is not benign. Such patients may receive second line, more expensive antibiotics, representing a significant impediment to antimicrobial stewardship. Aim of the review To (a) Explain the burden of spurious penicillin allergy, and evaluate the safety of direct oral penicillin challenge in 'low risk' patients (b) appraise the place for a clinical pharmacist-led penicillin allergy de-labelling programme. Method Narrative review. Search engines: PubMed, Google Scholar and Cochrane reviews. Search criteria: English language; search terms: penicillin allergy, antimicrobial stewardship, antimicrobial resistance, clostridium difficile, vancomycin resistant enterococci, risk stratification, clinical pharmacist and direct oral provocation test Results Penicillin allergy labels are associated with: longer hospital stay, higher readmission rates, enhanced risk of surgical site infections, risk of Clostridioides difficile infection and Methicillin resistant Staphylococcus aureus infection, a delay in the first dose of an antibiotic in sepsis and higher healthcare costs. A direct oral penicillin challenge in 'low risk' patients has proven to be safe. Discussion Recent studies including those led by a clinical pharmacist have demonstrated safety of a direct oral penicillin challenge in 'low risk' patients. This intervention needs validation within individual health services. Conclusion Direct oral penicillin challenge reduces the adverse impact of spurious penicillin allergy. A pharmacist-led penicillin allergy de-labelling program needs further validation in prospective multi-centre studies.
普通人群中有 6-10%，住院患者中有 15-20%被贴上青霉素过敏标签。>90%的这些标签在经过正式的过敏评估后被发现是虚假的。携带不必要的青霉素过敏标签并非良性。这些患者可能会接受二线、更昂贵的抗生素治疗，这对抗菌药物管理构成了重大障碍。
（a）解释虚假青霉素过敏的负担，并评估直接口服青霉素挑战在“低风险”患者中的安全性；（b）评估临床药师主导的青霉素过敏去标签计划的地位。
叙述性综述。搜索引擎：PubMed、Google Scholar 和 Cochrane 综述。搜索条件：英语语言；搜索词：青霉素过敏、抗菌药物管理、抗菌药物耐药性、艰难梭菌、万古霉素耐药肠球菌、风险分层、临床药师和直接口服激发试验。
青霉素过敏标签与以下因素相关：住院时间延长、再入院率增加、手术部位感染风险增加、艰难梭菌感染和耐甲氧西林金黄色葡萄球菌感染风险增加、脓毒症中抗生素首剂量延迟以及医疗保健费用增加。在“低风险”患者中进行直接口服青霉素挑战已被证明是安全的。
最近的研究，包括由临床药师领导的研究，已经证明了在“低风险”患者中进行直接口服青霉素挑战的安全性。该干预措施需要在各个卫生服务机构中进行验证。
直接口服青霉素挑战减少了虚假青霉素过敏的不良影响。临床药师主导的青霉素过敏去标签计划需要在前瞻性多中心研究中进一步验证。
