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Cited by 30Drug-Induced Adverse ReactionsAntibiotic Use and ResistancePharmacovigilance and Adverse Drug Reactions

Improving antimicrobial stewardship with penicillin allergy testing: a review of current practices and unmet needs

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Mabilat, Claude, Gros, Marie-Françoise, Van Belkum, Alex, Trubiano, Jason A, Blumenthal, Kimberly G, Romano, Antonino, Timbrook, Tristan T·2022·JAC-Antimicrobial Resistance
DOI 10.1093/jacamr/dlac116PMC PMC9675589
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Abstract

Penicillin allergy, the most frequently reported drug allergy, has been associated with suboptimal antibiotic therapy, increased antimicrobial resistance, increased rates of Clostridioides difficile colonization and infection, as well as extended hospital length of stay and increased cost. Although up to 10% of all patients may report penicillin allergy, most penicillin allergies are not confirmed. As such, most patients with a penicillin allergy can still safely use penicillin and related drugs following a more precise assessment. Herein, we review the current practices and unmet needs in penicillin allergy testing. The diagnostic algorithm is mostly based on a clinical history assessment followed by in vivo testing, i.e. skin test and/or drug challenge. As these tests are labour and resource intensive, there is increased interest in point-of-care penicillin allergy de-labelling solutions incorporated into Antimicrobial Stewardship Programmes including digital assessment tools. These can be locally parameterized on the basis of characteristics of target populations, incidence of specific allergies and local antibiotic usage to perform clinical risk stratification. Safely ruling out any residual risk remains essential and in vivo drug challenge and/or skin testing should be systematically encouraged. Gradual understanding and convergence of the risk stratification of the clinical presentation of penicillin allergy is enabling a wider implementation of this essential aspect of antimicrobial stewardship through digitalized decision tools and in vivo testing. More research is needed to deliver point of care in vitro diagnostic tools to democratize this de-labelling practice, which would be highly beneficial to patient care. This progress, together with better education of patients and clinicians about the availability, efficacy and safety of penicillin allergy testing, will increase the dissemination of penicillin allergy assessment as an important component of Antimicrobial Stewardship Programmes.

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Authors
Mabilat, C., Gros, M.-F., Van Belkum, A., Trubiano, J. A., Blumenthal, K. G., Romano, A., & Timbrook, T. T.
Affiliations
  • bioMérieux (France) (FR)
  • bioMérieux, Open Innovation and Partnerships , 3 Route du Port Michaud, 38390 La Balme Les Grottes , France
  • Austin Health (AU)
  • Harvard University (US)
  • Oasi Maria SS (IT)
  • BioFire Diagnostics (United States) (US)
Corresponding author
Mabilat, Claude
ORCID
Venue
JAC-Antimicrobial Resistance
Publisher
Oxford University Press (OUP)
Published
2022-11-03
Volume
4
Issue
6
Pages
dlac116-dlac116
ISSN
2632-1823 (ISSN-L)
DOI
10.1093/jacamr/dlac116
PMC
PMC9675589
OpenAlex
W4309562631
Cited by
30
References
3
Citations by year
2026: 5 · 2025: 5 · 2024: 12 · 2023: 8
FWCI
0.90
Type
journal article
Language
en
Open access
Licence
Locations
  • JAC-Antimicrobial Resistance (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Funders
  • National Health and Medical Research Council (GNT2008071)
  • National Institutes of Health (K01AI125631)
  • American Academy of Allergy Asthma and Immunology
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 › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords
penicillin allergy, penicillin allergy testing, antimicrobial stewardship, skin testing, drug challenge, point-of-care testing, risk stratification, antibiotic prescribing, Clostridium difficile infection, antimicrobial resistance

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