Preoperative skin test may reduce prophylactic antibiotic use
ATLANTA — Ninety-four percent of patients who reported a history of penicillin allergy and were scheduled to undergo surgery had negative penicillin allergy skin test results, according to data presented here. According to researchers, preoperative skin testing may reduce prophylactic antibiotic use in this patient population.
“The objective of this study was to try to see if we could reduce the use of prophylactic vancomycin, clindamycin and levofloxacin in patients with a history of penicillin allergy who are getting ready to go to surgery,” Arveen K. Thethi, MD, senior associate allergist, Mayo Clinic, Jacksonville, Fla., said during her presentation. “Basically, we created this new clinical pathway, working with our colleagues in the pre-op clinic.”
Arveen K. Thethi
Thethi and colleagues studied 384 patients who reported a history of penicillin allergy who were scheduled to undergo surgery and were referred for allergy consultation and penicillin allergy skin testing between August 2012 and August 2013. Percent reductions in the use of prophylactic vancomycin, levofloxacin and clindamycin in patients with a history of penicillin allergy compared with historical controls was the primary outcome.
Three hundred-sixty patients (94%) had negative penicillin allergy skin test results, which was higher than a previous study that reported 80% of patients who reported penicillin allergy had negative skin test results. Patients with negative skin test results were cleared to receive penicillin or cephalosporin antibiotics. When compared with historical controls, vancomycin was reduced by 54%, levofloxacin by 40%, and clindamycin by 22% within 6 months among patients who reported penicillin allergy.
“If you can work in a multidisciplinary capacity with your colleagues in surgery and anesthesia to come up with a system where these patients can come to the allergy department as part of their pre-op evaluation, collectively I think we can reduce the use of these broader-spectrum antibiotics,” Thethi concluded. “And more importantly, let patients know they are not allergic and they really can potentially open up their antibiotic armamentarium.”
For more information:
Disclosure: Healio Allergy/Immunology was unable to determine relevant financial disclosures at the time of publication.