Source/Disclosures
Disclosures: Blumenthal reports intellectual property for a clinical decision support tool used institutionally for beta-lactam allergy assessment at Partners HealthCare System, which is licensed to Persistent Systems. Please see the study for all other authors’ relevant financial disclosures.
June 29, 2020
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Patients with documented penicillin allergy more likely to receive ‘inferior’ antibiotics

Source/Disclosures
Disclosures: Blumenthal reports intellectual property for a clinical decision support tool used institutionally for beta-lactam allergy assessment at Partners HealthCare System, which is licensed to Persistent Systems. Please see the study for all other authors’ relevant financial disclosures.
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Hospitalized patients who had a documented penicillin allergy had higher odds of receiving “inferior” antibiotics — some that could potentially cause adverse drug events, data published in JAMA Internal Medicine show.

“To date, the inpatient prevalence and impact of documented penicillin allergies has been exclusively investigated in single hospitals or health care systems, and without data for the antibiotic indication,” Kimberly Blumenthal, MD, MSc, co-director of the clinical epidemiology program at Massachusetts General Hospital, told Healio Primary Care. “This is the largest and most detailed study of its kind.”

Adjusted odds ratios among inpatients with documented penicillin allergy:  OR = 1.94 Receiving alternative beta-lactam antibiotics;  OR = 5.34 Receiving clindamycin; and  OR = 0.35 Receiving narrow-spectrum antibiotics
Reference: Blumenthal KG, et al. JAMA Intern Med. 2020;doi:10.1001/jamainternmed.2020.2227.

Blumenthal and colleagues reviewed the medical records of 10,992 inpatients (mean age, 57 years; 51% men) who received antibiotics at one of 106 hospitals in the United States.

KImberly Blumenthal
Kimberly Blumenthal

According to the researchers, 16% of these patients had a documented penicillin allergy. In a fully adjusted analysis, patients with a documented penicillin allergy had increased odds of receiving an alternative beta-lactam antibiotic (aOR = 1.94; 95% CI, 1.74-2.17), especially clindamycin (aOR = 5.34; 95% CI, 3.99-7.13) — an antibiotic that has been associated with a risk for Clostridioides difficile. They also had lower odds of receiving a narrow-spectrum beta-lactam antibiotic (aOR = 0.35; 95% CI, 0.31-0.40).

Blumenthal and colleagues found that the association between documented penicillin allergy and receipt of alternative antibiotics was stronger among patients who received treatment for UTI (adjusted OR = 2.07; 95% CI, 1.51-2.85) and as prophylaxis for surgical procedures (aOR = 7.31; 95% CI, 5.01-10.69). Patients with a penicillin allergy documented in their medical record also had 18-fold increased odds of aztreonam use.

The researchers noted that more than 90% of documented penicillin allergies can be disproven, suggesting many of the patients in the study did not receive optimal treatment. They recommended that hospitals target patients prescribed clindamycin or patients with planned surgical procedures for inpatient penicillin allergy interventions.

“This type of large study makes it hard for hospitals to think that these findings are not generalizable to their own hospitals,” Blumenthal said. “It is somewhat concerning that we are not doing better.”