Impact of Proper Allergy Reporting of Antibiotics for Inpatients on a Routine Medical Floor

Background:

Penicillin is the most commonly reported allergy with 15-20% of patients admitted into the hospital claiming to be allergic, but prevalence is closer to 1-10%. Penicillins are often the drug of choice and the over reporting of allergies causes inappropriate broad spectrum antibiotics to be used as alternatives. After formal evaluation, it’s been found that 90-99% of patients with a reported allergy are able to tolerate penicillins. Therefore, proper allergy documentation and investigation into a patient’s profile to identify if they’ve ever received a penicillin or cephalosporin is essential. The objective of this study was to assess the over reporting of penicillin allergies by directing health care professionals to enter the patient’s reaction prior to initiating antibiotic therapy to reduce inappropriate broad antibiotic use.

Methods:

A daily electronic report identified patients with a reported penicillin allergy. Patients were identified that did not have an allergic reaction recorded. Of these, interviews were performed to determine the type of allergy. Other data collected: when the reaction occurred, age of the patient at this time, how it was treated, where on the body it occurred and any patient recollection of previous exposure to cephalosporins. The collected data was then entered into the patient’s chart.

Results:

327 patients reported having a penicillin allergy. Of these, 192 (58.7%) did not have a documented reaction and interventions were made on 169 of them. Out of the 169, 61 (36%) did not have a type 1 allergy. 38 of the 327 patients were readmitted. Interventions were made on 17 patients where it showed that days of therapy of meropenem (p=0.063) and aztreonam (p=0.136) were decreased compared to those not intervened on. Data collection also revealed 17% of patients with a reported penicillin allergy had previously taken a penicillin or cephalosporin with no reaction.

Conclusion:

Over reporting of penicillin allergies is an ongoing issue, but proper documentation of a patient’s allergy has been demonstrated to decrease the overuse of inappropriate broad spectrum antibiotics during their current or future stay. Education is an important part of ensuring healthcare professionals feel competent when documenting allergies.