Dataset Information

The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study.

ABSTRACT:

Background

Suspected penicillin allergy (Pen-A) is often not verified by diagnostic testing. In third line penicillin allergy labels were associated with prescription of broad spectrum antibiotics, hospital stay duration and readmission.

Objective

Assess the impact of Pen-A labels on antibiotic and health care use in primary care.

Methods

A retrospective cohort study was conducted in primary care in the Utrecht area, the Netherlands. All patients registered with a penicillin allergy on 31 December 2013 were selected from the General Practitioner Network database. Each patient with a Pen-A label was matched for age, gender, follow-up period with three patients without Pen-A label. Risk (OR) of receiving a reserve and second choice antibiotic, number and type of antibiotics prescribed during follow-up and number of GP contacts were compared between the two cohorts.

Results

Of 196,440 patients, 1254 patients (0.6%) with a Pen-A label were identified and matched with 3756 patients without Pen-A label. Pen-A labels resulted in higher risk of receiving ?1 antibiotic prescription per year (OR 2.56, 95% CI 2.05-3.20), ?1 s choice antibiotic prescription per year (OR 2.21 95% CI 1.11-4.40), and ?4 GP contacts per year (OR 1.71 95% CI 1.46-2.00). The chance of receiving tetracyclins (OR 2.24, 95% CI 1.29-3.89), macrolides/lincosamides/streptogamins (OR 8.69, 95% CI 4.26-17.73) and quinolones (OR 2.59, 95% CI 1.22-5.48) was higher in Pen-A patients.

Conclusions

In primary health care Pen-A labels are associated with increased antibiotic use, including second choice antibiotics, and more health care use.

SUBMITTER: Su T

PROVIDER: S-EPMC5461748 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study.

Su Tanly T Broekhuizen Berna D L BDL Verheij Theo J M TJM Rockmann Heike H

Clinical and translational allergy 20170607

<h4>Background</h4>Suspected penicillin allergy (Pen-A) is often not verified by diagnostic testing. In third line penicillin allergy labels were associated with prescription of broad spectrum antibiotics, hospital stay duration and readmission.<h4>Objective</h4>Assess the impact of Pen-A labels on antibiotic and health care use in primary care.<h4>Methods</h4>A retrospective cohort study was conducted in primary care in the Utrecht area, the Netherlands. All patients registered with a penicilli ...[more]

PMID: 28593040

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Project description:BackgroundAllergy documentation is frequently inconsistent and incomplete. The impact of this variability on subsequent treatment is not well described.ObjectiveTo determine how allergy documentation affects subsequent antibiotic choice.DesignRetrospective, cohort study.Participants232,616 adult patients seen by 199 primary care providers (PCPs) between January 1, 2009 and January 1, 2014 at an academic medical system.Main measuresInter-physician variation in beta-lactam allergy documentation; antibiotic treatment following beta-lactam allergy documentation.Key results15.6% of patients had a reported beta-lactam allergy. Of those patients, 39.8% had a specific allergen identified and 22.7% had allergic reaction characteristics documented. Variation between PCPs was greater than would be expected by chance (all p<0.001) in the percentage of their patients with a documented beta-lactam allergy (7.9% to 24.8%), identification of a specific allergen (e.g. amoxicillin as opposed to "penicillins") (24.0% to 58.2%) and documentation of the reaction characteristics (5.4% to 51.9%). After beta-lactam allergy documentation, patients were less likely to receive penicillins (Relative Risk [RR] 0.16 [95% Confidence Interval: 0.15-0.17]) and cephalosporins (RR 0.28 [95% CI 0.27-0.30]) and more likely to receive fluoroquinolones (RR 1.5 [95% CI 1.5-1.6]), clindamycin (RR 3.8 [95% CI 3.6-4.0]) and vancomycin (RR 5.0 [95% CI 4.3-5.8]). Among patients with beta-lactam allergy, rechallenge was more likely when a specific allergen was identified (RR 1.6 [95% CI 1.5-1.8]) and when reaction characteristics were documented (RR 2.0 [95% CI 1.8-2.2]).ConclusionsProvider documentation of beta-lactam allergy is highly variable, and details of the allergy are infrequently documented. Classification of a patient as beta-lactam allergic and incomplete documentation regarding the details of the allergy lead to beta-lactam avoidance and use of other antimicrobial agents, behaviors that may adversely impact care quality and cost.

Project description:OBJECTIVE:To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context. SETTING:Data were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017. DESIGN:Cohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report. PARTICIPANTS:Inpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs. RESULTS:A total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73) p<0.001). Guideline-adherence for CAP was higher if penicillin allergy (151 of 163; 92.6%) versus no allergy (582 of 810; 71.9%) (OR 0.20 (95% CI 0.10 to 0.37) p<0.001). There was no difference in adherence between those with and without penicillin allergy for UTI, HAP or SSTI treatment. CONCLUSIONS:A relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP, received more guideline adherent antibiotics than those without allergy. Future studies investigating the clinical impact of penicillin allergy should include data on adherence to antibiotic guidelines.

Dataset Information

The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study.

Background

Objective

Methods

Results

Conclusions

Publications

The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study.

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