Fransson Sara, Boel Jonas B, Mosbech Holger F, Garvey Lene H
Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
World Allergy Organ J. 2024 Aug 22;17(9):100958. doi: 10.1016/j.waojou.2024.100958. eCollection 2024 Sep.
Efforts to delabel penicillin allergic patients are important as the majority of suspected penicillin allergy can be ruled out by relevant allergy testing. The aim is to change the antibiotic pattern in delabeled patients to minimize use of unnecessary broad-spectrum antibiotics, reducing the risk of antimicrobial resistance and making treatment more cost effective. However, published information on subsequent antibiotic use is scarce. To evaluate the effect of delabeling on subsequent antibiotic use in primary care, a cohort of 2911 patients tested for penicillin allergy was compared to a matched control group of 14,522 individuals from the background population. In total 86.4% of the tested patients were delabeled. For delabeled patients, penicillin use increased from 0.07 prescriptions per patient year before allergy investigation, to 0.53 prescriptions per patient year post investigation (p < 0.001). The use of fluoroquinolones and macrolides was reduced and reached a level comparable to the background population. This study shows that penicillin allergy delabeling has significant positive impact on subsequent antibiotic use in primary care, and that penicillin use increases to levels similar to the background population. Penicillin allergy delabeling should be prioritized as an important and efficient element in antimicrobial stewardship initiatives.
对青霉素过敏患者进行脱敏的努力很重要，因为大多数疑似青霉素过敏可以通过相关过敏测试排除。目的是改变脱敏患者的抗生素使用模式，以尽量减少不必要的广谱抗生素使用，降低抗菌药物耐药性风险并提高治疗的成本效益。然而，关于后续抗生素使用的已发表信息很少。为了评估在初级保健中脱敏对后续抗生素使用的影响，将一组2911名接受青霉素过敏测试的患者与来自背景人群的14522名个体的匹配对照组进行了比较。总共86.4%的测试患者被脱敏。对于脱敏患者，青霉素使用量从过敏调查前的每位患者每年0.07张处方增加到调查后的每位患者每年0.53张处方（p < 0.001）。氟喹诺酮类和大环内酯类药物的使用减少，达到了与背景人群相当的水平。这项研究表明，青霉素过敏脱敏对初级保健中后续抗生素使用有显著的积极影响，并且青霉素使用量增加到与背景人群相似的水平。青霉素过敏脱敏应作为抗菌药物管理举措中的一个重要且有效的要素予以优先考虑。
