Macy E
Kaiser Permanente, San Diego Medical Center, Department of Allergy, UCSD School of Medicine, Calif, USA.
J Allergy Clin Immunol. 1998 Aug;102(2):281-5. doi: 10.1016/s0091-6749(98)70097-1.
Elective penicillin skin testing in advance of acute antibiotic need and amoxicillin challenge in patients with negative skin test responses have not been evaluated.
I reviewed 236 patients previously entered in a study of new penicillin reagents who received at least 1 prescription drug over a 2-year period. Antibiotic use, outpatient visit rate, and adverse reactions to antibiotics during the year before and after skin testing were evaluated.
Forty (17%) of the 236 subjects had positive responses. Antibiotic courses dispensed to the 236 subjects fell 28% from 779 the year before testing to 558 the year after testing. The total cost for antibiotics dispensed fell 32% from $17,211.88 to $11,648.27, with a 5.5% reduction in the average cost per antibiotic. Outpatient visit rate did not change but shifted from primary to specialty departments in subjects with both positive and negative skin test responses. In 93 subjects with negative skin test responses, a total of 188 therapeutic courses of penicillin during the year after testing resulted in 3 (3.2%) unrechallenged mild adverse reactions. Optional amoxicillin challenge in 146 of the subjects with negative skin test responses resulted in complaints of an adverse reaction in 6 of these subjects. Four of these received a penicillin analogue in the next year without reaction.
Elective penicillin skin testing done by an allergist was associated with unexpected declines in the number and cost of antibiotics used the year after testing but only modestly lowered the average cost per antibiotic. Adverse reactions to penicillins in subjects with negative skin test responses were infrequent, and amoxicillin challenge did not affect outcomes.
在急性需要抗生素之前进行选择性青霉素皮肤试验以及对皮肤试验反应阴性的患者进行阿莫西林激发试验尚未得到评估。
我回顾了236名先前参与一项新型青霉素试剂研究的患者，这些患者在两年期间至少接受了1种处方药治疗。评估了皮肤试验前后一年的抗生素使用情况、门诊就诊率以及抗生素不良反应。
236名受试者中有40名（17%）反应呈阳性。分配给这236名受试者的抗生素疗程从试验前一年的779个降至试验后一年的558个，下降了28%。抗生素配药总成本从17,211.88美元降至11,648.27美元，下降了32%，每种抗生素的平均成本降低了5.5%。门诊就诊率没有变化，但皮肤试验反应阳性和阴性的受试者的门诊就诊科室从初级科室转向了专科科室。在93名皮肤试验反应阴性的受试者中，试验后一年共进行了188个青霉素治疗疗程，导致3例（3.2%）未经再次激发的轻度不良反应。对146名皮肤试验反应阴性的受试者进行的选择性阿莫西林激发试验导致其中6名受试者出现不良反应投诉。其中4人在次年接受了青霉素类似物治疗，未出现反应。
由过敏症专科医生进行的选择性青霉素皮肤试验与试验后一年使用的抗生素数量和成本意外下降有关，但仅适度降低了每种抗生素的平均成本。皮肤试验反应阴性的受试者对青霉素的不良反应很少见，阿莫西林激发试验并未影响结果。
