Management of Antimicrobial Allergies by Infectious Diseases Physicians Interview with: Lilian Abbo, M.D.
Associate Professor of Clinical Medicine
Division of Infectious Diseases
University of Miami Miller School of Medicine
Medical Director of Antimicrobial Stewardship Program
Jackson Memorial Hospital and University of Miami Hospita What are the main findings of the study?

Dr. Abbo: We surveyed 744/1411 (53%) members of the Infectious Diseases Society of America Emerging Infectious Network to evaluate ID physicians’ perceptions about patients’ reported antimicrobial allergies and the availability of resources to confirm antimicrobial allergic reactions. 78% of the respondents had been consulted at least once in their past month about the management of patients with reported antibiotic allergy. 60% reported that penicillin skin testing (ST) was available at their facilities. The main barriers to perform ST were unavailability of test materials or personnel to perform the test. Our results show that ID physicians play an important role in diagnosing and managing patients who report antimicrobial allergies, and are receptive to education and guidance to better manage these patients. Were any of the findings unexpected?

Dr. Abbo: We had three vignettes with common scenarios encountered in clinical practice. Interestingly 38% of the respondents would have treated a patient with methicillin susceptible Staphylococcus aureus (MSSA) bacteremia with vancomycin. These results have important implications as receipt of nafcillin or cefazolin in MSSA bacteremic patients is independently associated with a 79% lower adjusted rate of mortality compared to vancomycin. What should clinicians and patients take away from your report?

Dr. Abbo: Based on our findings, we hope that clinicians will consider prescribing antibiotics judiciously for their patients, and carefully evaluate if the patient has a true allergic reaction before prescribing alternative agents.

For individual patients, we encourage them to speak with their doctor about a possible antibiotic allergy, how was it diagnosed, how long ago, what kind of reaction they. Patients with poor recollection or a questionable past medical history about an antibiotic related allergy could also discuss the possibility of being referred to an allergy specialist, to confirm if they are truly allergic to the antibiotic. What recommendations do you have for future research as a result of this study?

Dr. Abbo: Because the development of new antimicrobial agents is on the decline and antimicrobial resistant infections are becoming an important public health hazard worldwide, antimicrobial stewardship efforts are aimed to preserve the effectiveness of the existing agents and avoid the collateral damage associated with the use of antibiotics. Minimizing unnecessary antibiotic use and correctly identifying antimicrobial allergies could significantly reduce the immediate and direct risks of drug-related adverse events in adults and children.

Future research could focus on: evaluating the impact of reported allergies on antimicrobial stewardship and antimicrobial resistance; implementing and evaluating the impact of educating patients and healthcare providers about the diagnosis of antibiotic allergies, and developing clinical practice guidelines for the use of antibiotics in patients with confirmed allergic reactions to first line agents.


Management of Antimicrobial Allergies by Infectious Diseases Physicians

Lilian M. Abbo, MD; Susan E. Beekmann, RN, MPH; Thomas M. Hooton, MD; Birgir Johannsson, MD; Philip M. Polgreen, MD, MPH; for the Infectious Diseases Society of AmericaEmerging Infections Network

JAMA Intern Med. 2013;():1-2. doi:10.1001/jamainternmed.2013.6480

Published online June 3, 2013


Last Updated on September 19, 2013 by Marie Benz MD FAAD