scholarly journals The Basics of Penicillin Allergy: What A Clinician Should Know

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 94 ◽  
Author(s):  
Louis Lteif ◽  
Lea S. Eiland
Keyword(s):  
Antimicrobial Agents ◽  
Adult Population ◽  
The United States ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Patient Specific ◽  
Beta Lactam ◽  
Clinically Significant ◽  
Medication Allergy ◽  
Specific Reactions

Antimicrobials in the penicillin class are first line treatments for several infectious diseases in the pediatric and adult population today. In the United States, patients commonly report having a penicillin allergy, with penicillin being the most frequent beta-lactam allergy. However, very few patients experience a clinically significant immune-mediated allergic reaction to penicillin. If a true penicillin allergy exists, cross-reactivity to other beta-lactam antimicrobials may occur. Mislabeling patients with penicillin allergy can lead to a higher utilization of second line antimicrobial agents, potentially increasing costs and resistance due to a larger spectrum of activity. Pharmacists play an essential role in inquiring about patient specific reactions to presumed medication allergies and developing a further assessment plan, if needed, to determine if the medication allergy is real.

scholarly journals 162. Assessment of Beta-lactam Allergies as Rationale for Receipt of Vancomycin for Surgical Prophylaxis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kendall J Tucker ◽  
YoungYoon Ham ◽  
Haley K Holmer ◽  
Caitlin M McCracken ◽  
Ellie Sukerman ◽  
...  
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Skin Testing ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Beta Lactam ◽  
First Line ◽  
Surgical Prophylaxis ◽  
Inappropriate Use ◽  
Oral Amoxicillin ◽  
Ige Mediated

Abstract Background Beta-lactam (BL) antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between classes of BLs, patients with allergies commonly receive vancomycin as an alternative to avoid allergic reaction. The objective of this study was to identify potentially inappropriate use of vancomycin surgical prophylaxis among patients with reported BL allergies. Methods Adult patients (≥18 years) receiving vancomycin for surgical prophylaxis with a reported penicillin and/or cephalosporin allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis. Surgery type and allergy history were extracted from the electronic medical record. Per our institution’s penicillin-testing protocol, patients with IgE-mediated reactions < 10 years ago were eligible for penicillin skin testing (PST), mild reactions or IgE-mediated reaction > 10 years ago were eligible for direct oral amoxicillin challenge, and severe non-IgE mediated allergies were ineligible for penicillin allergy evaluation or BL prophylaxis. Results Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported BL allergy and were included in the analysis (155 with penicillin allergy alone; 21 with cephalosporin allergy; 20 with both cephalosporin and penicillin allergy). Approximately 40% of surgeries were orthopedic. Six patients were ineligible for BL prophylaxis. Per institutional protocol, 73 of 155 patients (48%) may have qualified for PST; 81 of 155 (52%) patients may have received a direct oral amoxicillin challenge. Only 3 of 22 patients with history of methicillin-resistant Staphylococcus aureus appropriately received additional prophylaxis with vancomycin and a BL. Conclusion Patients with BL allergies often qualify for receipt of a first-line BL antibiotic. An opportunity exists for improved BL allergy assessment as an antimicrobial stewardship intervention. Future studies should evaluate outcomes associated with BL allergy evaluation and delabeling in patients receiving surgical prophylaxis. Disclosures All Authors: No reported disclosures

A Practical Look at the Clinical Usefulness of the Beta-Lactam/Beta-Lactamase Inhibitor Combinations

1996 ◽  
Vol 30 (10) ◽  
pp. 1130-1140 ◽  
Author(s):  
Susan M. Hart ◽  
Elaine M. Bailey
Keyword(s):  
English Language ◽  
Antimicrobial Agents ◽  
In Vivo Studies ◽  
Patient Specific ◽  
Beta Lactamase ◽  
Beta Lactam ◽  
Intraabdominal Infections ◽  
Lactamase Inhibitor

OBJECTIVE: To aid clinicians in developing an approach to the use of intravenous beta-lactam/beta-lactamase inhibitors on a patient-specific basis. To achieve this, the pharmacology, in vitro activity, and clinical use of the intravenous beta-lactam/beta-lactamase inhibitor combinations in the treatment of selected infections seen in hospitalized patients are discussed. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1987–1995); Index Medicus (1987–1995); program and abstracts of the 32nd (1992), 33rd (1993), 34th (1994), and 35th (1995) Interscience Conference on Antimicrobial Agents and Chemotherapy; bibliographic reviews of review articles; and package inserts. STUDY SELECTION: In vitro and in vivo studies on the pharmacokinetics, microbiology, pharmacology, and clinical effectiveness of ampicillin/sulbactam, ticarcillin/clavulanate, and piperacillin/tazobactam were evaluated. DATA SYNTHESIS: Many properties of the beta-lactam/beta-lactamase inhibitor combinations are similar. Differences in dosing, susceptibilities, and clinical applications are important considerations for clinicians. Potential roles for these agents in the clinical setting include pneumonia, intraabdominal infections, and soft tissue infections. A short discussion on susceptibility data interpretation is also presented. CONCLUSIONS: There are important differences among the available beta-lactam/beta-lactamase inhibitor combinations, such as spectra of activity, which need to be considered in choosing an agent for a patient-specific case. These products can be useful alternatives to conventional two- to three-drug regimens in mixed infections such as foot infections in patients with diabetes and hospital-acquired intraabdominal infections.

Streptococcus pneumoniae: An Update on Resistance Patterns in the United States

2008 ◽  
Vol 21 (5) ◽  
pp. 363-370 ◽  
Author(s):  
Jessica A. Starr ◽  
Georgia W. Fox ◽  
Jennifer K. Clayton
Keyword(s):  
United States ◽  
Streptococcus Pneumoniae ◽  
Antimicrobial Agents ◽  
Respiratory Infections ◽  
Tetracycline Resistance ◽  
The United States ◽  
Multidrug Resistant ◽  
Beta Lactam ◽  
Resistance Patterns ◽  
Surveillance Programs

Streptococcus pneumoniae represents an important pathogen in numerous community-acquired respiratory infections. Penicillin resistance to Streptococcus pneumoniae in the United States has approached 35%. Additionally, there has been a significant increase in Streptococcus pneumoniae resistance among many other antimicrobial agents such as cephalosporins, macrolides, trimethoprim–sulfamethoxazole, clindamycin, tetracyclines, and chloramphenicol. Several nationwide surveillance programs have been implemented to quantify the prevalence of Streptococcus pneumoniae resistance in the United States. Overall, beta-lactam, macrolide, trimethoprim–sulfamethoxazole, and tetracycline resistance has increased over the past decade while later generation fluoroquinolones (levofloxacin and moxifloxacin) resistance has remained low. Controlling the spread of resistant pneumococcal isolates and preventing the development of both fluoroquinolone and multidrug resistant isolates will require a multidisciplinary approach involving physicians, pharmacists, microbiologists, and epidemiologists.

Incidence of interruptive penicillin allergy alerts in patients with previously documented beta-lactam exposure: Potential for leveraging the electronic health record to identify erroneous allergies

2021 ◽  
pp. 1-4
Author(s):  
Nicole Van Groningen ◽  
Ray Duncan ◽  
Galen Cook-Wiens ◽  
Aaron Kwong ◽  
Matthew Sonesen ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Medical Center ◽  
Tertiary Care ◽  
Penicillin Allergy ◽  
Health Record ◽  
Beta Lactam ◽  
Tertiary Care Medical Center ◽  
Lactam Antibiotic ◽  
Electronic Health ◽  
Clinically Significant

Abstract Background: Approximately 10% of patients report allergies to penicillin, yet >90% of these allergies are not clinically significant. Patients reporting penicillin allergies are often treated with second-line, non–β-lactam antibiotics that are typically broader spectrum and more toxic. Orders for β-lactam antibiotics for these patients trigger interruptive alerts, even when there is electronic health record (EHR) data indicating prior β-lactam exposure. Objective: To describe the rate that interruptive penicillin allergy alerts display for patients who have previously had a β-lactam exposure. Design: Retrospective EHR review from January 2013 through June 2018. Setting: A nonprofit health system including 1 large tertiary-care medical center, a smaller associated hospital, 2 emergency departments, and ˜250 outpatient clinics. Participants: All patients with EHR-documented of penicillin allergies. Methods: We examined interruptive penicillin allergy alerts and identified the number and percentage of alerts that display for patients with a prior administration of a penicillin class or other β-lactam antibiotic. Results: Of 115,081 allergy alerts that displayed during the study period, 8% were displayed for patients who had an inpatient administration of a penicillin antibiotic after the allergy was noted, and 49% were displayed for patients with a prior inpatient administration of any β-lactam. Conclusions: Many interruptive penicillin allergy alerts display for patients who would likely tolerate a penicillin, and half of all alerts display for patients who would likely tolerate another β-lactam.

scholarly journals Antimicrobial Resistance among Clinical Isolates ofStreptococcus pneumoniae in the United States during 1999–2000, Including a Comparison of Resistance Rates since 1994–1995

2001 ◽  
Vol 45 (6) ◽  
pp. 1721-1729 ◽  
Author(s):  
Gary V. Doern ◽  
Kristopher P. Heilmann ◽  
Holly K. Huynh ◽  
Paul R. Rhomberg ◽  
Stacy L. Coffman ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Rank Order ◽  
The United States ◽  
Clinical Isolates ◽  
Beta Lactam ◽  
High Level ◽  
Resistance Rates

ABSTRACT A total of 1,531 recent clinical isolates of Streptococcus pneumoniae were collected from 33 medical centers nationwide during the winter of 1999–2000 and characterized at a central laboratory. Of these isolates, 34.2% were penicillin nonsusceptible (MIC ≥ 0.12 μg/ml) and 21.5% were high-level resistant (MIC ≥ 2 μg/ml). MICs to all beta-lactam antimicrobials increased as penicillin MICs increased. Resistance rates among non-beta-lactam agents were the following: macrolides, 25.2 to 25.7%; clindamycin, 8.9%; tetracycline, 16.3%; chloramphenicol, 8.3%; and trimethoprim-sulfamethoxazole (TMP-SMX), 30.3%. Resistance to non-beta-lactam agents was higher among penicillin-resistant strains than penicillin-susceptible strains; 22.4% of S. pneumoniae were multiresistant. Resistance to vancomycin and quinupristin-dalfopristin was not detected. Resistance to rifampin was 0.1%. Testing of seven fluoroquinolones resulted in the following rank order of in vitro activity: gemifloxacin > sitafloxacin > moxifloxacin > gatifloxacin > levofloxacin = ciprofloxacin > ofloxacin. For 1.4% of strains, ciprofloxacin MICs were ≥4 μg/ml. The MIC90s (MICs at which 90% of isolates were inhibited) of two ketolides were 0.06 μg/ml (ABT773) and 0.12 μg/ml (telithromycin). The MIC90 of linezolid was 2 μg/ml. Overall, antimicrobial resistance was highest among middle ear fluid and sinus isolates of S. pneumoniae; lowest resistance rates were noted with isolates from cerebrospinal fluid and blood. Resistant isolates were most often recovered from children 0 to 5 years of age and from patients in the southeastern United States. This study represents a continuation of two previous national studies, one in 1994–1995 and the other in 1997–1998. Resistance rates with S. pneumoniae have increased markedly in the United States during the past 5 years. Increases in resistance from 1994–1995 to 1999–2000 for selected antimicrobial agents were as follows: penicillin, 10.6%; erythromycin, 16.1%; tetracycline, 9.0%; TMP-SMX, 9.1%; and chloramphenicol, 4.0%, the increase in multiresistance was 13.3%. Despite awareness and prevention efforts, antimicrobial resistance with S. pneumoniae continues to increase in the United States.

PP43 Decision-Making Tool In Case Of Beta-Lactam Allergy: How To Help Clinicians?

2019 ◽  
Vol 35 (S1) ◽  
pp. 45-45
Author(s):  
Sylvie Bouchard ◽  
Geneviève Robitaille ◽  
Fatiha Karam ◽  
Jean-Marc Daigle ◽  
Mélanie Tardif
Keyword(s):  
Primary Care ◽  
Meta Analysis ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Initial Reaction ◽  
Knowledge Mobilization ◽  
Beta Lactam ◽  
Skin Reactions ◽  
Increased Risk ◽  
Work Health

IntroductionBeta-lactams (BLs), especially penicillins, are the most commonly used antibiotics, particularly in primary care, and one of the most reported drug allergies. Fearing cross-reactivity, clinicians refrain from prescribing another BL (e.g., cephalosporin or carbapenem) to penicillin-allergic patients. This can have significant consequences for the patients and the health-care system (e.g., exposure to broad-spectrum antibiotics, increased risk adverse effects, and increased healthcare costs).MethodsTo assess the absolute cross-reactivity risk, two systematic reviews with meta-analysis were conducted. Then, an approach based on a knowledge mobilization framework considering scientific, contextual and experiential evidences was used. Focus groups with stakeholders, including primary care clinicians, pediatricians, infectious disease specialists and allergists/immunologists, were also held to meet the needs of all actors concerned.ResultsFollowing this work, it appears that true allergies to penicillin are very rare. Indeed, in patients with a history of penicillin allergy, very few are truly allergic and thus the risk of cross-reaction with another BL is even lower, varying according to structural and physicochemical similarities with alleged-penicillin. Moreover, the risk of having an anaphylactic reaction after penicillin exposure is very low, especially among children. As well, in patients with confirmed penicillin allergy, the observed reactions are usually delayed non-severe skin reactions. However, with a confirmed penicillin allergy, it is important to remain cautious when administering a new BL, especially if the initial reaction was serious or severe. Based on these key messages, a decision aid including an algorithm was developed. Likewise, individualized algorithms for common infections met in primary care were produced.ConclusionsFrom this work, health professionals non-specialized in allergology should be able to better manage the risks attributed to penicillin allergies. Therefore, patients should receive the most effective and safe antibiotics to treat their clinical conditions in primary care.

scholarly journals Overview of Beta-Lactam Allergy and the Role of the Pharmacist in Management

Allergies ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 128-136
Author(s):  
Nicole Bradley ◽  
Yuman Lee ◽  
Dana Weinstein
Keyword(s):  
Public Health ◽  
Antibiotic Therapy ◽  
Skin Testing ◽  
Public Health Problem ◽  
Cross Reactivity ◽  
Vital Role ◽  
Beta Lactam ◽  
Increased Risk ◽  
Clinically Significant

Unverified beta-lactam allergies are a substantial public health problem, as the majority of patients labeled as beta-lactam allergic do not have clinically significant allergies that may hinder the use beta-lactam therapy when indicated. Outdated or inaccurate beta-lactam or penicillin allergies can result in serious consequences, including suboptimal antibiotic therapy, increased risk of adverse effects, and use of broader spectrum antibiotics than indicated, which may contribute to antimicrobial resistance. The purpose of this review is to provide an overview of beta-lactam allergy and highlight the role of pharmacists in managing beta-lactam allergies. Studies have shown that pharmacists can play a vital role in allergy assessment, penicillin skin testing, beta-lactam desensitization, evaluation of beta-lactam cross-reactivity and recommending appropriate antibiotic therapy in patients with beta-lactam allergies.

scholarly journals 171. Effectiveness and Feasibility of Pharmacist-Driven Penicillin Allergy De-Labeling Pilot Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S93-S93
Author(s):  
Youchan Song ◽  
Zachary Nelson ◽  
Krista Gens
Keyword(s):  
Program Implementation ◽  
Skin Testing ◽  
Surgical Site Infections ◽  
Cross Reactivity ◽  
Adverse Outcomes ◽  
Penicillin Allergy ◽  
Beta Lactam ◽  
Patient Interview ◽  
Clostridioides Difficile ◽  
Increased Risk

Abstract Background Prevalence of true hypersensitivity to penicillins is low (0.5–2%). Documented penicillin allergies have been associated with an increased risk of adverse outcomes, including methicillin resistant Staphylococcus aureus infections, Clostridioides difficile infections, and surgical site infections. “De-labeling” of inappropriately documented allergies can decrease the use of unnecessary broad-spectrum antibiotics and prevent negative outcomes, but labor-intensive skin testing and oral challenges can be a barrier to program implementation. The goal of this project is to assess the effectiveness and feasibility of a pharmacist-led penicillin allergy de-labeling process that does not involve skin testing or oral challenges. Methods Adult patients with penicillin allergies were identified using a report within the electronic health record during a 3-month pilot period. Patients identified were interviewed by an infectious diseases pharmacy resident, and an allergy history was assessed utilizing a standardized checklist. The patients’ answers determined the ability to de-label via pharmacist utilization of an evidence-based and standardized checklist developed for this project. All documentation included a detailed patient allergy history along with a beta-lactam cross-reactivity chart to help guide future antibiotic choices. Results 66 patients were interviewed during the pilot. 12 patients (18%) met criteria for de-labeling and consented to the removal of the allergy. 4 patients (6%) met criteria for de-labeling but declined the removal of the allergy. Average time spent during patient interview was 5.2 minutes per patient. 58.3% of patients (7/12) who were de-labeled were subsequently prescribed a beta-lactam, and 100% (7/7) were able to tolerate the agents. 1 out of 4 patients (25%) who declined de-labeling but had their allergy updated to reflect intolerance was prescribed beta-lactams and was able to tolerate the agents (1/1, 100%). Conclusion A pharmacist-led penicillin allergy de-labeling process utilizing a standardized checklist is an effective method for removing penicillin allergies in patients who do not have a true allergy to penicillins. This pharmacist-led process is a feasible method for sites unable to perform oral challenges or skin testing. Disclosures All Authors: No reported disclosures

Can increases in Twitter posts predict increases in cumulative incidence of COVID-19 in the United States? Evidence that social media can inform epidemic surveillance. (Preprint)

2020 ◽  
Author(s):  
Ruoyan Sun ◽  
Henna Budhwani
Keyword(s):  
Public Health ◽  
United States ◽  
Cumulative Incidence ◽  
Hot Spots ◽  
Adult Population ◽  
State Level ◽  
The United States ◽  
Education Attainment ◽  
Public Health Systems ◽  
Per Capita

BACKGROUND Though public health systems are responding rapidly to the COVID-19 pandemic, outcomes from publicly available, crowd-sourced big data may assist in helping to identify hot spots, prioritize equipment allocation and staffing, while also informing health policy related to “shelter in place” and social distancing recommendations. OBJECTIVE To assess if the rising state-level prevalence of COVID-19 related posts on Twitter (tweets) is predictive of state-level cumulative COVID-19 incidence after controlling for socio-economic characteristics. METHODS We identified extracted COVID-19 related tweets from January 21st to March 7th (2020) across all 50 states (N = 7,427,057). Tweets were combined with state-level characteristics and confirmed COVID-19 cases to determine the association between public commentary and cumulative incidence. RESULTS The cumulative incidence of COVID-19 cases varied significantly across states. Ratio of tweet increase (p=0.03), number of physicians per 1,000 population (p=0.01), education attainment (p=0.006), income per capita (p = 0.002), and percentage of adult population (p=0.003) were positively associated with cumulative incidence. Ratio of tweet increase was significantly associated with the logarithmic of cumulative incidence (p=0.06) with a coefficient of 0.26. CONCLUSIONS An increase in the prevalence of state-level tweets was predictive of an increase in COVID-19 diagnoses, providing evidence that Twitter can be a valuable surveillance tool for public health.

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