Beta-Lactam Allergy: Documentation Matters
Background: Beta-lactam allergy documentation is frequently incomplete and lacks instructive value in guiding beta-lactam antibiotic rechallenge. How clinical decision-making and antibiotic choice is affected by allergy documentation is not well described.
Methods: We performed a retrospective, descriptive study of all patients seen by a NorthShore University HealthSystem primary care provider between 2008 and 2013. Beta-lactam allergy information, first antibiotic prescribed after allergy entry and subgrouping of allergy description was performed with an Enterprise Data Warehouse.
Results: The study included 234,233 total patients seen by NorthShore primary care providers of which 15.2% had a reported beta-lactam allergy. There were 21,196 unique patients with a beta-lactam allergy who received antibiotics. 79.2% had no details of the reaction documented, 58.0% did not have a specific beta-lactam identified, and 3.1% had a high risk reaction (IgE mediated or severe reaction). Patients with beta-lactam allergy were less likely than those without to receive subsequent penicillins and cephalosporins, and more likely to be treated with fluoroquinolones, clindamycin and macrolides (Figure 1). Patients with details of the reaction documented as compared to those without such documentation were more likely to receive a subsequent penicillin (6.1% vs 2.8%; p<0.001) or cephalosporin (7.3% vs 4.0%; p<0.001). Similarly, patients who had a specific beta-lactam identified were more likely to receive a subsequent penicillin (5.3% vs 2.2%; p<0.001) or cephalosporin (5.3% vs 4.3%; p=0.01). Patients with no details of the reaction documented had the same likelihood of beta-lactam rechallenge as those with a high-risk reaction: penicillin (2.8% vs 3.6%; p=0.22); cephalosporin (4.0% vs 4.2%; p=0.84).
Conclusion: The more complete the penicillin allergy documentation the more likely a patient was to receive a beta-lactam antibiotic and less likely to receive macrolides, fluoroquinolones or clindamycin. Providers may be assuming the highest risk reaction for those patients without an allergy description. Completing allergy documentation should be a high priority to improve quality of care and reduce costs.
N. Pettit, None
A. Robicsek, None