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Ann Allergy Asthma Immunol. 2016 Jul;117(1):67-71. doi: 10.1016/j.anai.2016.04.021. Epub 2016 May 20.

Penicillin skin testing in hospitalized patients with β-lactam allergies: Effect on antibiotic selection and cost.

Author information

1
Department of Pharmacy, Atlantic Health System, Overlook Medical Center, Summit, New Jersey. Electronic address: esther.king@atlantichealth.org.
2
Department of Medicine, Banner Baywood Medical Center, Mesa, Arizona.
3
Department of Pharmacy, Atlantic Health System, Overlook Medical Center, Summit, New Jersey.
4
Department of Medicine, Atlantic Health System, Overlook Medical Center, Summit, New Jersey; Division of Allergy and Immunology, Rutgers University Robert Wood Johnson University Hospital, New Brunswick, New Jersey; School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.

Abstract

BACKGROUND:

A history of a penicillin allergy generally leads to the use of broad-spectrum antibiotics that may increase complications and cost.

OBJECTIVE:

To determine the cost-effectiveness of performing penicillin skin testing (PST).

METHODS:

A retrospective analysis was conducted on adult inpatients with a β-lactam allergy who underwent PST and oral challenge performed by an allergist. The primary outcome was overall antibiotic cost savings for patients switched to a β-lactam antibiotic (BLA). Secondary outcomes included subsequent admissions that required antibiotics and total number of days a BLA was prescribed.

RESULTS:

Fifty patients had PST performed (mean age, 62 years). The most common β-lactam allergy reported was penicillin (92%). Cutaneous reactions were reported in 54% of patients, and 56% had a reaction more than 20 years ago. Fifty percent of patients had aztreonam prescribed before PST. The results of PST were negative in all patients, and 1 patient had anaphylactic symptoms during the oral amoxicillin challenge (98% skin test or oral challenge negative). Thirty-seven patients (75.5%) were changed to a BLA. Overall cost savings were $11,005 ($297 per patient switched to a BLA). There were 31 subsequent admissions that required antibiotics for patients who tested negative on skin test and oral challenge. A BLA was prescribed in 22 of 31 readmissions, totaling 147 days of BLA therapy.

CONCLUSION:

After the implementation of a PST protocol, we observed a decrease in non-BLA use in patients with previously documented β-lactam allergy. PST is a safe and cost-effective procedure to serve as a negative predictor test for penicillin hypersensitivity mediated by IgE.

PMID:
27211057
DOI:
10.1016/j.anai.2016.04.021
[Indexed for MEDLINE]

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