Implementation of an infectious disease fellow-managed penicillin allergy skin testing service.
Open accessAbstract
Abstract Background. A large percentage of patients presenting to acute care facilities report penicillin allergies that are associated with suboptimal antibiotic therapy. Penicillin skin testing (PST) can clarify allergy histories but is often limited by access to testing. We aimed to implement an infectious diseases (ID) fellow-managed PST program and to assess the need for PST via national survey. Methods. We conducted a prospective observational study of the implementation of an ID fellow-managed penicillin allergy skin testing service. The primary outcome of the study was to assess the feasibility and acceptability of an ID fellow-managed PST service and its impact on the optimization of antibiotic selection. In addition, a survey of PST practices was sent out to all ID fellowship program directors in the United States. Results. In the first 11 months of the program, 90 patients were assessed for PST and 76 patients were tested. Of the valid tests, 96% were negative, and 84% with a negative test had antibiotic changes; 63% received a narrower spectrum antibiotic, 80% received more effective therapy, and 61% received more cost-effective therapy. The majority of survey of respondents (n = 50) indicated that overreporting of penicillin allergy is a problem in their practice that affects antibiotic selection but listed inadequate personnel and time as the main barriers to PST. Conclusions. Inpatient PST can be successfully managed by ID fellows, thereby promoting optimal antibiotic use in patients reporting penicillin allergies. This model can increase access to PST at institutions without adequate access to allergists while also providing an important educational experience to ID trainees.
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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 [678]
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Antibiotic use and financial impact of a comprehensive beta-lactam allergy management program
Raja, K., Vyas, L., Morrison, S., Beggs, D., Patel, M., & Philips, M. (2025) · Antimicrobial Stewardship & Healthcare Epidemiology · doi:10.1017/ash.2025.36
- Authors
- Heil, E. L., Bork, J. T., Schmalzle, S. A., Kleinberg, M., Kewalramani, A., Gilliam, B. L., & Buchwald, U. K.
- Affiliations
- University of Maryland, Baltimore (US)
- Johns Hopkins University (US)
- Department of Medicine, Division of Infectious Diseases
- Corresponding author
- Heil, Emily L.
- ORCID
- Venue
- Open Forum Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2016
- Volume
- 3
- Issue
- 3
- Pages
- ofw155-ofw155
- ISSN
- 2328-8957 (ISSN-L)
- PMC
- PMC5047432
- OpenAlex
- W2470658779
- Cited by
- 66
- References
- 23
- Citations by year
- 2025: 3 · 2024: 6 · 2023: 3 · 2022: 9 · 2021: 8 · 2020: 6 · 2019: 15 · 2018: 7 · 2017: 8 · 2016: 1
- FWCI
- 8.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Open Forum Infectious Diseases (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- penicillin allergy, penicillin skin testing, antibiotic stewardship, antibiotic selection, infectious disease training
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