23 Aug ID Fellow Managed Clinic Helps Determine True Penicillin Allergies
MedicalResearch.com Interview with:
Emily L. Heil, PharmD, BCPS-AQ ID
Department of Pharmacy Practice and Science
University of Maryland School of Pharmacy
20 N Pine St
Baltimore, Maryland 21201
MedicalResearch.com: What is the background for this study?
Response: As many as nine out of ten people who think they are allergic to penicillin are, in fact, not allergic when penicillin allergy skin testing is performed. This mistaken belief, confirmed in multiple other studies and a matter of concern of the U.S. Centers for Disease Control and Prevention (CDC), has widespread implications given that patients who report penicillin allergies tend to get suboptimal antibiotic therapy compared with patients who do not. Penicillin skin testing (PST) can clarify allergy histories but is often limited by access to testing. We aimed to implement an infectious disease (ID) fellow managed PST program and to assess the need for PST via national survey. Our study found that inpatient Penicillin skin testing can be successfully managed by ID fellows, thereby promoting optimal antibiotic use. Our study showed that by testing patients for penicillin allergy via skin test, we could improve their care: 80 percent of patients were able to switch to more effective antibiotic therapy once they were tested.
MedicalResearch.com: What are the main findings?
Response: Our key findings indicate that treatment can be improved as a result of penicillin allergy testing:
• 84% of patients who tested negative for penicillin allergy had their antibiotics changed
• 63% received a narrower spectrum antibiotic
• 80% received more effective therapy
• and 61% received more cost effective therapy.
MedicalResearch.com: What should readers take away from your report?
Response: The takeaway is that getting skin-tested is critical to determine true penicillin allergy and ensure the best treatment with the least medical risk. Nationally, the over-reporting of penicillin allergy is problem faced in practice that affects antibiotic selection, according to our survey of ID fellowship program directors. They listed inadequate personnel and time as the main barriers to PST, but our study found that inpatient Penicillin skin testing can be successfully managed by ID fellow at hospitals without access to allergists.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We should continue to identify novel ways to increase access for patients to penicillin allergy skin testing. Otherwise, the fact that penicillin allergy is often greatly overstated may continue to jeopardize patient treatment.
Our Infectious Diseases fellows proved to be a great resource. For hospitals lacking allergists, pilot programs that train physician fellows or other capable professionals in Penicillin skin testing are warranted and deserve study, given the significant health implications of a false penicillin allergy.
MedicalResearch.com: Is there anything else you would like to add?
Response: Many of our patients have been thrilled to learn that an inaccurate history of penicillin “allergy” does not have to stay on their chart for a lifetime. Skin testing has given them – and their physicians – the clarity to seek optimize their antibiotic therapy.
It’s our hope that more providers will embrace penicillin skin testing to improve antibiotic stewardship in the healthcare industry. Earlier this year, the CDC said every hospital should consider screening patients for penicillin allergy as a basic strategy to stop antibiotic misuse and over-prescribing. The CDC concluded: “when evaluated, fewer than 1% of the population are truly allergic to penicillins,” and “approximately 80 percent of patients with IgE-mediated penicillin allergy lose their sensitivity after 10 years.”
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Implementation of an Infectious Disease Fellow Managed Penicillin Allergy Skin Testing Service Emily L. Heil; Jacqueline T. Bork; Sarah A. Schmalzle; Michael Kleinberg; Anupama Kewalramani; Bruce L. Gilliam; Ulrike K. Buchwald. Open Forum Infectious Diseases 2016:
For more on penicillin allergy testing visit: http://www.prepen.com.
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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