In the JournalsPerspective

Making the case for pharmacist-administered penicillin skin test

Experts have suggested a bigger role for pharmacists in penicillin skin testing, writing in Clinical Infectious Diseases that it would expand access to the service and be good for antimicrobial stewardship efforts.

“Processes to assess the likelihood of a patient having a penicillin allergy need to be made more available with a multidisciplinary approach,” Eunah Cheon, PharmD, BCPS, clinical pharmacy coordinator at New York-Presbyterian Brooklyn Methodist Hospital, and Harold W. Horowitz, MD, an infectious disease specialist in the department of medicine at New York-Presbyterian Brooklyn Methodist Hospital and professor of clinical medicine at Weill Cornell Medical College, wrote. “Penicillin allergy is one of the most frequently self-reported drug allergies in the United States population, with an incidence ranging from 10% to 20%, with less than 1% being truly allergic.”

Cheon and Horowitz noted that alternate treatment options are limited for patients who report a penicillin allergy and that road-spectrum antibiotics, which are more expensive, may compromise intravenous to oral de-escalation and can induce extensive resistance, are frequently prescribed instead. They said many providers do not “feel comfortable” using penicillin despite the development of several penicillin allergy screening and testing guideline-based algorithms, and that penicillin skin testing (PST) is only available in about 60% of health care institutions anyway.

Cheon and Horowitz asked state boards of pharmacy in all 50 U.S. states and Washington, D.C., if PST is included in the scope of practice of a pharmacist under state regulations. Of the 38 that responded, only 31.5% (n = 12) permitted pharmacists to administer PST.

Cheon and Horowitz said that, because 48 states now permit some type of pharmacist and prescriber collaborative practice agreements, there is “potential” to expand the role of pharmacist-directed PST.

“Today, pharmacists have authority to administer immunizations in all 50 states and D.C. and this has led to increased immunization rates,” they wrote. “Advancing pharmacists’ roles to provide PST would be a step in the same direction and we suspect an important contribution to patient care.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

Experts have suggested a bigger role for pharmacists in penicillin skin testing, writing in Clinical Infectious Diseases that it would expand access to the service and be good for antimicrobial stewardship efforts.

“Processes to assess the likelihood of a patient having a penicillin allergy need to be made more available with a multidisciplinary approach,” Eunah Cheon, PharmD, BCPS, clinical pharmacy coordinator at New York-Presbyterian Brooklyn Methodist Hospital, and Harold W. Horowitz, MD, an infectious disease specialist in the department of medicine at New York-Presbyterian Brooklyn Methodist Hospital and professor of clinical medicine at Weill Cornell Medical College, wrote. “Penicillin allergy is one of the most frequently self-reported drug allergies in the United States population, with an incidence ranging from 10% to 20%, with less than 1% being truly allergic.”

Cheon and Horowitz noted that alternate treatment options are limited for patients who report a penicillin allergy and that road-spectrum antibiotics, which are more expensive, may compromise intravenous to oral de-escalation and can induce extensive resistance, are frequently prescribed instead. They said many providers do not “feel comfortable” using penicillin despite the development of several penicillin allergy screening and testing guideline-based algorithms, and that penicillin skin testing (PST) is only available in about 60% of health care institutions anyway.

Cheon and Horowitz asked state boards of pharmacy in all 50 U.S. states and Washington, D.C., if PST is included in the scope of practice of a pharmacist under state regulations. Of the 38 that responded, only 31.5% (n = 12) permitted pharmacists to administer PST.

Cheon and Horowitz said that, because 48 states now permit some type of pharmacist and prescriber collaborative practice agreements, there is “potential” to expand the role of pharmacist-directed PST.

“Today, pharmacists have authority to administer immunizations in all 50 states and D.C. and this has led to increased immunization rates,” they wrote. “Advancing pharmacists’ roles to provide PST would be a step in the same direction and we suspect an important contribution to patient care.” – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Jeff Brock

    Jeff Brock

    As a pharmacist who provides allergy screening and penicillin skin testing services, I have found that providing this service is greatly appreciated by both providers and patients. This paper highlights the need for pharmacists to have discussions with legislators and boards of pharmacy about the implications unsubstantiated penicillin allergies have for our patients. The literature shows a clear benefit of pharmacist-provided penicillin skin testing. It was surprising to me that only 31.5% of the states responding to the survey allowed pharmacists to perform these tests. However, I would like to know how many of the 12 states that did not respond also allow pharmacists to perform these tests. I do agree that there are obstacles for the programs that are mainly pharmacy-led because of a lack of a standard training program. Performing the tests is not unusually difficult, but I have realized over the years of doing them that there is an art to it that can be gained only through training and experience. An area for future research would be to evaluate pharmacy billing practices because reimbursement is a common question many have when starting a pharmacy-based skin testing service.

    • Jeff Brock, PharmD, MBA, BCPS AQ-ID
    • Infectious disease pharmacy specialist
      Mercy Medical Center
      Des Moines, Iowa

    Disclosures: Brock reports no relevant financial disclosures.