Pharmacy Department, Royal Cornwall Hospital Trust, Truro, UK.
Allergy and Immunology Department, Respiratory Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
Clin Microbiol Infect. 2023 Oct;29(10):1338.e1-1338.e4. doi: 10.1016/j.cmi.2023.06.024. Epub 2023 Jun 22.
Penicillin allergy records are common, often incorrect and are associated with broad spectrum antibiotic use. We piloted a pharmacist-led multidisciplinary penicillin allergy de-labelling daily ward round to determine the opportunity for penicillin allergy de-labelling in a UK hospital.
A daily ward round, delivered by antibiotic pharmacists or junior doctors, identified adult medical and surgical patients between 7 November 2022 and 31 January 2023 with a penicillin allergy record that was preventing first-line penicillin use. An allergy history was taken before risk stratifying likelihood of future harm from penicillin re-exposure and an allergy testing method was determined (direct de-label on history alone or after direct drug provocation testing). After successful allergy de-label, the antibiotic was switched to a penicillin antibiotic.
Of 7214 inpatients during the study period, 1133 (15.7%) had a penicillin allergy record. Of 285 allergy histories taken, 105 (36.8%) met high-risk criteria, 45 (15.8%) met low-risk criteria eligible for direct de-label and 73 (25.6%) met criteria eligible for direct drug provocation testing. We were unable to obtain a history for 61 (21.4%) patients. Of 45 low-risk patients eligible for direct de-label, 40 (88.9%) were de-labelled of whom 24 (53.3%) were switched to a penicillin antibiotic. Of 73 patients with a low-risk allergy history eligible for direct drug provocation testing, 16 (21.9%) received direct drug provocation testing, of whom 9 were switched to a penicillin antibiotic. Two direct de-label patients experienced harm (thrush within 5 days and delayed skin reaction after day 5); none of the direct drug provocation testing patients had a reaction by day 5. The switches resulted in reduced alternative antibiotic use by 173 Daily Defined Doses (DDDs).
Penicillin allergy de-labelling patient pathway delivered by pharmacists and junior doctors was safe and effective and well accepted by patients and the wider clinical teams.
青霉素过敏记录很常见，且通常是不正确的，并与广谱抗生素的使用有关。我们试行由药剂师主导的多学科青霉素过敏去标签每日病房查房，以确定在英国医院进行青霉素过敏去标签的机会。
由抗生素药剂师或初级医生进行的每日病房查房，确定了 2022 年 11 月 7 日至 2023 年 1 月 31 日期间，有青霉素过敏记录且该记录阻止了一线青霉素使用的成年内科和外科住院患者。在对青霉素再次暴露后发生潜在危害的可能性进行风险分层之前，会采集过敏史，并确定过敏测试方法（仅根据病史直接去标签，或在直接药物激发试验后去标签）。成功去标签过敏后，将抗生素更换为青霉素抗生素。
在研究期间的 7214 名住院患者中，有 1133 名（15.7%）有青霉素过敏记录。在采集的 285 份过敏史中，105 名（36.8%）符合高风险标准，45 名（15.8%）符合低风险标准，适合直接去标签，73 名（25.6%）符合直接药物激发试验标准。我们无法获得 61 名（21.4%）患者的病史。在 45 名符合直接去标签标准的低风险患者中，有 40 名（88.9%）去标签，其中 24 名（53.3%）更换为青霉素抗生素。在 73 名有低风险过敏史且适合直接药物激发试验的患者中，有 16 名（21.9%）接受了直接药物激发试验，其中 9 名更换为青霉素抗生素。两名直接去标签患者出现了不良反应（5 天内出现鹅口疮和 5 天后出现迟发性皮肤反应）；没有直接药物激发试验患者在第 5 天出现不良反应。这些转换减少了 173 个日剂量（DDD）的替代抗生素使用。
由药剂师和初级医生提供的青霉素过敏去标签患者途径是安全有效的，并且得到了患者和更广泛的临床团队的认可。
