Most clinicians are well aware of the increase in antimicrobial resistance and the death toll associated with infections caused by drug-resistant pathogens. In the United States, more than 2.8 million antimicrobial-resistant infections occur each year, resulting in more than 35,000 deaths, according to the Centers for Disease Control and Prevention.
The adoption of hospital antimicrobial stewardship programs (ASPs) has helped to minimize inappropriate antibiotic prescribing. However, the misdiagnosis of penicillin allergies still remains a major problem. Patients listed with a penicillin allergy are often treated with more expensive second-line antibiotics and are at higher risk of developing a drug-resistant infection. As discussed in our cover story, more than 95% of patients “with a documented allergy can tolerate β-lactam drugs,” wrote Alma Sabovic, DNP, MS, APRN, and colleagues. “The unnecessary use of alternative antibiotics [in these patients] is associated with higher health care costs, increased risk of antibiotic resistance, and suboptimal antibiotic therapy.”
Many people are incorrectly told they have a penicillin allergy based on an experience they had as a child. In fact, 1 out of 10 patients who report a penicillin allergy do not actually have an allergy. Approximately 80% of people will outgrow a penicillin allergy within 10 years.
The pilot study conducted by Dr Sabovic and colleagues exposed some knowledge gaps among clinicians in one hospital in Connecticut, most of whom were in practice for more than 10 years. The best way to assess for a penicillin allergy is to conduct a thorough medication allergy assessment, which can help distinguish a drug hypersensitivity reaction from a true allergy. However, the majority of respondents spent less than 2 minutes assessing medication allergies and never consulted allergy/immunology for antibiotic allergy skin testing in patients with a questionable penicillin allergy.
The pilot study findings should raise awareness of this issue and prompt providers to assess and re-evaluate patients with a penicillin allergy. A lesson all practitioners should take to heart.