J A Trubiano1,2,3, L J Worth4,5, K Urbancic6,7, T M Brown8, D L Paterson8, M Lucas9, E Phillips10,11. 1. Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia. jason.trubiano@austin.org.au. 2. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. jason.trubiano@austin.org.au. 3. Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. jason.trubiano@austin.org.au. 4. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 5. Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. 6. Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia. 7. Department of Pharmacy, Austin Health, Melbourne, Victoria, Australia. 8. Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia. 9. Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia. 10. Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia. 11. Department of Medicine, Vanderbilt Medical Center, Nashville, Tennessee, USA.
Abstract
BACKGROUND/AIM: Antibiotic allergies are frequently reported and have significant impacts upon appropriate prescribing and clinical outcomes. We surveyed infectious diseases physicians, allergists, clinical immunologists and hospital pharmacists to evaluate antibiotic allergy knowledge and service delivery in Australia and New Zealand. METHODS: An online multi-choice questionnaire was developed and endorsed by representatives of the Australasian Society of Clinical Immunology and Allergy (ASCIA) and the Australasian Society of Infectious Diseases (ASID). The 37-item survey was distributed in April 2015 to members of ASCIA, ASID, the Society of Hospital Pharmacists of Australia and the Royal Australasian College of Physicians. RESULTS: Of 277 respondents, 94% currently use or would utilise antibiotic allergy testing (AAT) and reported seeing up to 10 patients/week labelled as antibiotic-allergic. Forty-two per cent were not aware of or did not have AAT available. Most felt that AAT would aid antibiotic selection, antibiotic appropriateness and antimicrobial stewardship (79, 69 and 61% respectively). Patients with the histories of immediate hypersensitivity were more likely to be referred than those with delayed hypersensitivities (76 vs 41%, P = 0.0001). Lack of specialist physicians (20%) and personal experience (17%) were barriers to service delivery. A multidisciplinary approach was a preferred AAT model (53%). Knowledge gaps were identified, with the majority overestimating rates of penicillin/cephalosporin (78%), penicillin/carbapenem (57%) and penicillin/monobactam (39%) cross-reactivity. CONCLUSIONS: A high burden of antibiotic allergy labelling and demand for AAT is complicated by a relative lack availability or awareness of AAT services in Australia and New Zealand. Antibiotic allergy education and deployment of AAT, accessible to community and hospital-based clinicians, may improve clinical decisions and reduce antibiotic allergy impacts. A collaborative approach involving infectious diseases physicians, pharmacists and allergists/immunologists is required.
BACKGROUND/AIM: Antibiotic allergies are frequently reported and have significant impacts upon appropriate prescribing and clinical outcomes. We surveyed infectious diseases physicians, allergists, clinical immunologists and hospital pharmacists to evaluate antibiotic allergy knowledge and service delivery in Australia and New Zealand. METHODS: An online multi-choice questionnaire was developed and endorsed by representatives of the Australasian Society of Clinical Immunology and Allergy (ASCIA) and the Australasian Society of Infectious Diseases (ASID). The 37-item survey was distributed in April 2015 to members of ASCIA, ASID, the Society of Hospital Pharmacists of Australia and the Royal Australasian College of Physicians. RESULTS: Of 277 respondents, 94% currently use or would utilise antibiotic allergy testing (AAT) and reported seeing up to 10 patients/week labelled as antibiotic-allergic. Forty-two per cent were not aware of or did not have AAT available. Most felt that AAT would aid antibiotic selection, antibiotic appropriateness and antimicrobial stewardship (79, 69 and 61% respectively). Patients with the histories of immediate hypersensitivity were more likely to be referred than those with delayed hypersensitivities (76 vs 41%, P = 0.0001). Lack of specialist physicians (20%) and personal experience (17%) were barriers to service delivery. A multidisciplinary approach was a preferred AAT model (53%). Knowledge gaps were identified, with the majority overestimating rates of penicillin/cephalosporin (78%), penicillin/carbapenem (57%) and penicillin/monobactam (39%) cross-reactivity. CONCLUSIONS: A high burden of antibiotic allergy labelling and demand for AAT is complicated by a relative lack availability or awareness of AAT services in Australia and New Zealand. Antibiotic allergy education and deployment of AAT, accessible to community and hospital-based clinicians, may improve clinical decisions and reduce antibiotic allergy impacts. A collaborative approach involving infectious diseases physicians, pharmacists and allergists/immunologists is required.
Authors: A Romano; F Gaeta; R L Valluzzi; C Alonzi; M Maggioletti; A Zaffiro; C Caruso; D Quaratino Journal: Allergy Date: 2013-11-04 Impact factor: 13.146
Authors: P Demoly; A Romano; C Botelho; L Bousquet-Rouanet; F Gaeta; R Silva; G Rumi; J Rodrigues Cernadas; P J Bousquet Journal: Allergy Date: 2009-10-26 Impact factor: 13.146
Authors: Jason A Trubiano; Rekha Pai Mangalore; Yi-Wei Baey; Duy Le; Linda V Graudins; Patrick G P Charles; Douglas F Johnson; Ar Kar Aung Journal: Med J Aust Date: 2016-04-18 Impact factor: 7.738
Authors: Jason A Trubiano; Cosby A Stone; M Lindsay Grayson; Karen Urbancic; Monica A Slavin; Karin A Thursky; Elizabeth J Phillips Journal: J Allergy Clin Immunol Pract Date: 2017-08-23
Authors: Jason A Trubiano; Karin A Thursky; Andrew J Stewardson; Karen Urbancic; Leon J Worth; Cheryl Jackson; Wendy Stevenson; Michael Sutherland; Monica A Slavin; M Lindsay Grayson; Elizabeth J Phillips Journal: Clin Infect Dis Date: 2017-07-01 Impact factor: 9.079
Authors: Jason A Trubiano; M Lindsay Grayson; Karin A Thursky; Elizabeth J Phillips; Monica A Slavin Journal: Med J Aust Date: 2018-06-18 Impact factor: 7.738
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Authors: Katherine Collins; Kristina Rueter; Michaela Lucas; David Sommerfield; Aine Sommerfield; Nazim Khan; Britta S von Ungern-Sternberg Journal: J Paediatr Child Health Date: 2022-05-03 Impact factor: 1.929
Authors: Jason A Trubiano; Sara Vogrin; Kyra Y L Chua; Jack Bourke; James Yun; Abby Douglas; Cosby A Stone; Roger Yu; Lauren Groenendijk; Natasha E Holmes; Elizabeth J Phillips Journal: JAMA Intern Med Date: 2020-05-01 Impact factor: 44.409