Matthieu Picard1, Philippe Bégin2, Hugues Bouchard3, Jonathan Cloutier3, Jonathan Lacombe-Barrios4, Jean Paradis4, Anne Des Roches5, Brian Laufer3, Louis Paradis4. 1. Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada; Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada. Electronic address: matthieu.picard@umontreal.ca. 2. Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada; Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada. 3. Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada. 4. Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada. 5. Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.
Abstract
BACKGROUND: Prescribing antibiotics to patients with a history of penicillin allergy is common in clinical practice. Opting for non-beta-lactam antibiotics has its inconveniences and is often unnecessary, because most of these patients are in fact not allergic. OBJECTIVE: This study aimed to determine how physicians in a large Canadian tertiary-care academic hospital without allergists on staff treat patients with a history of penicillin allergy. METHODS: A retrospective study was conducted during a 1-year period among all patients hospitalized in the intensive care unit, coronary care unit, and internal medicine wards. Files of patients with a record of penicillin allergy were reviewed to assess the need for antibiotics during their hospitalization and the decision-making process underlying the choice of antibiotic. The additional costs of alternative antibiotics were calculated. RESULTS: The files of 1738 patients admitted over a 1-year period were hand reviewed. A history of penicillin allergy was found in 172 patients (9.9%). The allergic reaction was described in only 30% of cases and left unmentioned in 20.7%. Beta-lactam antibiotics were used on 56 occasions despite a history of penicillin allergy. The use of alternative antibiotics in place of the beta-lactam standard of care carried an additional cost of $15,672 Canadian. CONCLUSION: Alleged penicillin allergy is common among hospitalized patients and leads to substantial additional costs. Poor documentation of penicillin allergy likely reflects a lack of knowledge on this issue in the medical community, which impairs optimal treatment of these patients. Increased education on this matter is needed, and allergists on staff could be part of the solution.
BACKGROUND: Prescribing antibiotics to patients with a history of penicillinallergy is common in clinical practice. Opting for non-beta-lactam antibiotics has its inconveniences and is often unnecessary, because most of these patients are in fact not allergic. OBJECTIVE: This study aimed to determine how physicians in a large Canadian tertiary-care academic hospital without allergists on staff treat patients with a history of penicillinallergy. METHODS: A retrospective study was conducted during a 1-year period among all patients hospitalized in the intensive care unit, coronary care unit, and internal medicine wards. Files of patients with a record of penicillinallergy were reviewed to assess the need for antibiotics during their hospitalization and the decision-making process underlying the choice of antibiotic. The additional costs of alternative antibiotics were calculated. RESULTS: The files of 1738 patients admitted over a 1-year period were hand reviewed. A history of penicillinallergy was found in 172 patients (9.9%). The allergic reaction was described in only 30% of cases and left unmentioned in 20.7%. Beta-lactam antibiotics were used on 56 occasions despite a history of penicillinallergy. The use of alternative antibiotics in place of the beta-lactam standard of care carried an additional cost of $15,672 Canadian. CONCLUSION: Alleged penicillinallergy is common among hospitalized patients and leads to substantial additional costs. Poor documentation of penicillinallergy likely reflects a lack of knowledge on this issue in the medical community, which impairs optimal treatment of these patients. Increased education on this matter is needed, and allergists on staff could be part of the solution.
Keywords:
Allergist; Antibiotic; Cost-effectiveness; Drug allergy; Education; Intensive care unit; Internal medicine; Management; Penicillin allergy; Quality of care
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