Data_Sheet_1_Penicillin Allergy De-labeling Results in Significant Changes in Outpatient Antibiotic Prescribing Patterns.PDF

Unverified penicillin allergies are common but most patients with a penicillin allergy label can safely use penicillin antibiotics. Penicillin allergy labels are associated with poor clinical outcomes and overuse of second-line antibiotics. There is increasing focus on penicillin allergy “de-labeling” as a tool to improve antibiotic prescribing and antimicrobial stewardship. The effect of outpatient penicillin allergy de-labeling on long-term antibiotic use is uncertain. We performed a retrospective pre- and post- study of antibiotic dispensing patterns, from an electronic dispensing data repository, in patients undergoing penicillin allergy assessment at Auckland City Hospital, New Zealand. Over a mean follow-up of 4.55 years, 215/304 (70.7%) of de-labeled patients were dispensed a penicillin antibiotic. Rates of penicillin antibiotic dispensing were 0.24 (0.18–0.30) penicillin courses per year before de-labeling and 0.80 (0.67–0.93) following de-labeling with a reduction in total antibiotic use from 2.30 (2.06–2.54) to 1.79 (1.59–1.99) antibiotic courses per year. In de-labeled patients, the proportion of antibiotic courses that were penicillin antibiotics increased from 12.81 to 39.62%. Rates of macrolide, cephalosporin, trimethoprim/co-trimoxazole, fluoroquinolone, “other” non-penicillin antibiotic use, and broad-spectrum antibiotic use were all lower following de-labeling. Further, antibiotic costs were lower following de-labeling. In this study, penicillin allergy de-labeling was associated with significant changes in antibiotic dispensing patterns.

未经证实的青霉素过敏症虽普遍存在，然而大多数被标注为青霉素过敏的患者可以安全地使用青霉素类抗生素。青霉素过敏的标注与不良的临床预后及二线抗生素的过度使用相关联。目前，对青霉素过敏“去标签化”的关注日益增加，将其视为改善抗生素处方和抗菌药物管理的工具。门诊青霉素过敏去标签化对长期抗生素使用的影响尚不明确。本研究通过回顾性前后对照研究，分析了新西兰奥克兰市医院进行青霉素过敏评估的患者在电子处方数据仓库中的抗生素配发模式。在平均随访4.55年的过程中，304名患者中有215名（70.7%）去标签化患者接受了青霉素抗生素。去标签化前，青霉素抗生素的配发率为每年0.24（0.18–0.30）个疗程，去标签化后为每年0.80（0.67–0.93）个疗程，总抗生素使用量从每年2.30（2.06–2.54）个疗程降至1.79（1.59–1.99）个疗程。在去标签化患者中，使用青霉素抗生素的疗程比例从12.81%增加到39.62%。去标签化后，大环内酯类、头孢菌素类、甲氧苄啶/复方新诺明、氟喹诺酮类、“其他”非青霉素类抗生素和广谱抗生素的使用率均有所降低。此外，去标签化后抗生素的花费也相应减少。本研究表明，青霉素过敏去标签化与抗生素配发模式的显著变化相关。