261. Alternative Antibiotic Prescribing for Community Acquired Pneumonia (CAP) in Pediatric Patients in Relation to Allergy Status
Session: Poster Abstract Session: Pediatric Antimicrobial and Diagnostic Stewardship
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Abx for CAP in relation to allergy status PDF.pdf (638.4 kB)
  • Background:

    While 10% of the population may report a penicillin (PCN) allergy, it has been shown that 90% of these patients are not allergic and may still be able to take PCN safely. Inaccurate reporting of a PCN allergy may lead to prescription of other non-B-lactam or broader spectrum antibiotics. Inpatients with reported antibiotic allergy status have been shown to have inappropriate antibiotic prescribing, increase microbiologic resistance, and suboptimal patient outcomes. Our goal was to evaluate antibiotic prescribing patterns for children with CAP in the setting of reported antibiotic allergy.

    Methods:

    The Children’s Hospital’s Initiative for Research in Pneumonia (CHIRP) study enrolled inpatient and outpatient children ≥ 2 months to 18 years of age with a diagnosis of CAP from six participating sites. Demographic data, allergy status, antimicrobial therapy, and clinical outcomes were collected. Overall prevalence of reported antibiotic allergy and alternative therapy used in setting of reported allergy were analyzed.

    Results:

    470 subjects were included, enrolled from October 2015 to December 2017. The mean age was 6.3 years (range: 3 mth to 18.9 yr), 45% were females. 63 (13.4%) subjects self-reported one or more antibiotic allergies. 27 subjects reported amoxicillin (AMOX) allergy, 9 with PCN allergy, 9 with amox/clavulanate (AMOX/CLAV) allergy, and 11 with ampicillin (AMP) or ampicillin/sulbactam allergy. Cephalosporin allergy was reported in 7 subjects. Of the 47 subjects that reported AMOX or AMP allergy, 37 (79%) were treated with ceftriaxone, a broad-spectrum agent. In the 47 subjects with reported AMOX or AMP allergy, 5 (10.6%) were prescribed AMOX at discharge. Of the 3 subjects with reported levofloxacin allergy, 2 were treated with levofloxacin during hospitalization for CAP as well as at the time of discharge.

    Conclusion:

    Most subjects with reported AMOX allergy were treated with alternative and broader spectrum antibiotics. In our cohort, 10.6% still received the antibiotic despite the allergy labeling. Better confirmation of allergy history to hone appropriate antimicrobial therapy appears to be indicated.

    Ankita Desai, MD1, Bhavana Gorti, MS2, Sherman Alter, MD3, Lilliam Ambroggio, PhD, MPH4, Daniel Cohen, MD5, Osama El-Assal, MD6, Todd Florin, MD, MSCE4,7, Meghan Keaton, MD8, Asuncion Mejias, MD, PhD, MsCS5, Richard Ruddy, MD4, Samir Shah, MD4, Rebecca Wallihan, MD5, Octavio Ramilo, MD, FPIDS5 and Children’s Hospitals Initiative for Research in Pneumonia (CHIRP), (1)Division of Pediatric Infectious Diseases, University Hospitals Cleveland Medical Center/Rainbow Babies and Children's Hospital, Cleveland, OH, (2)University Hospitals Cleveland Medical Center, Cleveland, OH, (3)Dayton Children’s Hospital, Dayton, OH, (4)Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, (5)The Research Institute at Nationwide Children’s Hospital, Columbus, OH, (6)Akron Children's Hospital, Akron, OH, (7)University of Cincinnati College of Medicine, Cincinnati, OH, (8)ProMedica Toledo Children’s Hospital, Toledo, OH

    Disclosures:

    A. Desai, None

    B. Gorti, None

    S. Alter, None

    L. Ambroggio, None

    D. Cohen, Nationwide Children's Hospital: Research Contractor , Research support .

    O. El-Assal, None

    T. Florin, None

    M. Keaton, None

    A. Mejias, Janssen: Grant Investigator and Scientific Advisor , Consulting fee and Research grant . Abbvie: CME talks , Speaker honorarium .

    R. Ruddy, None

    S. Shah, None

    R. Wallihan, None

    O. Ramilo, Janssen Scientific Affairs, LLC: Consultant , Consulting fee . Sanofi: Scientific Advisor , Consulting fee . Merck: Scientific Advisor , Consulting fee and Speaker honorarium . Janssen: Grant Investigator and Scientific Advisor , Consulting fee , Grant recipient and Speaker honorarium . Pfizer: Consultant , Consulting fee and Speaker honorarium .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.