Implementation of a pharmacist-led penicillin allergy de-labelling service in a public hospital.
Abstract
BACKGROUND: Inaccurate allergy labelling results in inappropriate antimicrobial management of the patient, which may affect clinical outcome, increase the risk of adverse events and increase costs. Inappropriate use of alternative antibiotics has implications for antimicrobial stewardship programmes and microbial resistance. METHODS: All adult inpatients labelled as penicillin allergic were identified and screened for eligibility by the study pharmacist. An accurate allergy and medication history was taken. Patients were 'de-labelled', underwent oral challenge or were referred to an immunology clinic, if study criteria were met. All patients included in the study were followed-up 1 year after intervention. RESULTS: Two hundred and fifty eligible patients with a label of 'penicillin allergy' were identified. The prevalence of reported penicillin allergy at Middlemore Hospital was 11%. We found that 80% of study patients could be 'de-labelled'. Of those, 80% were 'de-labelled' after an interview with the pharmacist alone, 16% had an uneventful oral challenge and 4% were deemed to be inappropriately labelled after referral to an immunology clinic. Appropriately labelled patients accounted for 20% of the study population. Changes to inpatient antibiotic therapy were recommended in 61% of 'de-labelled' patients, of which no patients had adverse events after commencing on penicillin antibiotics. At the 1 year follow-up, 98% of patients who were 'de-labelled' had no adverse events to repeated administration of penicillin antibiotics. CONCLUSIONS: This study showed that a pharmacist-led allergy management service is a safe option to promote antimicrobial stewardship and appropriate allergy labelling.
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Penicillin skin testing has become a clinically significant element in antibiotic stewardship programs, and the procedure has been increasingly used by hospital-based pharmacists, hospitalists, and infectious disease physicians as part of overall antibiotic stewardship interventions.
“Penicillin skin testing has become a clinically significant element in antibiotic stewardship programs, and the procedure has been increasingly used by hospital-based pharmacists, hospitalists, and infectious disease physicians (670,672,673,678,679) as part of overall antibiotic stewardship interventions.”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [679]
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
- Authors
- du Plessis, T., Walls, G., Jordan, A., & Holland, D. J.
- Affiliations
- Infection Services, Middlemore Hospital, Auckland, New Zealand
- Middlemore Hospital (NZ)
- Auckland City Hospital (NZ)
- ORCID
- Walls, Genevieve
- Venue
- Journal of Antimicrobial Chemotherapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-02-06
- Volume
- 74
- Issue
- 5
- Pages
- 1438-1446
- ISSN
- 0305-7453 (ISSN-L)
- 1460-2091
- OpenAlex
- W2913987477
- Cited by
- 117
- References
- 32
- Citations by year
- 2026: 9 · 2025: 25 · 2024: 16 · 2023: 18 · 2022: 11 · 2021: 15 · 2020: 13 · 2019: 10
- FWCI
- 7.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Antimicrobial Chemotherapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Departments of Pharmacy and Infectious Diseases of Middlemore Hospital
- Topics
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- penicillin allergy, pharmacist-led services, oral drug challenge, allergy screening, antimicrobial stewardship, inappropriate antibiotic use, adverse drug reactions
- MeSH terms
- Antimicrobial Stewardship, Aged, Aged, 80 and over, Anti-Bacterial Agents, Drug Hypersensitivity, Female, Health Plan Implementation, Hospitals, Public, Humans, Male, Middle Aged, New Zealand, Penicillins, Pharmacists, Product Labeling, Prospective Studies, Skin, Skin Tests, Self Report
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