Article Text

Download PDFPDF

4CPS-122 Overview of the impact of penicillin allergy labels on antibiotic use in the emergency department
  1. G Garreta,
  2. N Meca,
  3. C Sebastian,
  4. M Iglesias,
  5. F Salazar,
  6. J Pardo,
  7. J Nicolas
  1. H. U. Mutua de Terrassa, Pharmacy, Terrassa, Spain


Background and importance Many patients claim to be allergic to penicillin (Pen-A); however, only 10–25% of these are truly penicillin-allergic. It needs to be established if they are truly allergic (type-1 allergy) in order to to indicate alternative antibiotics. Moreover, patients who do not have a type-1 allergy can safely receive cephalosporins or carbapenems, but having a label of Pen-A may be associated with prescription of broad-spectrum antibiotics (BSA), hospital stay duration and readmission.

Aim and objectives Assess the impact of Pen-A labels on antibiotic in an emergency department (ED).

Identify patients who remain appropriate candidates to receive beta-lactam therapy or cephalosporins, are mislabelled or may be dis-labelled with penicillin allergy skin testing (PST).

Material and methods Retrospective cohort study with ED cases treated with BSA from January 2020–January 2021.

Pen-A were identified by assessing all allergies in the electronic medical record. Each patient with a Pen-A label was matched for age, gender, BSA prescribed in ED and previous exposures to penicillin or cephalosporins.

PST may be considered if they meet any of the criteria recommended: history of Pen-A >10 years ago, frequent antibiotic use required, immunosuppressed state and history of infections caused by multidrug-resistant (MDR) bacteria.

Results A total of 287 patients (mean age 62 years; SD 16 years; 53% men) were enrolled.

The main antibiotic prescribed in Pen-A patients were quinolones (49%) and macrolides/lincosamides (21%). In 88% cases, antibiotic hospital guides suggested treatments with a cephalosporin.

Of 46 patients with Pen-A, 24 had non-type 1/non-severe reaction, 6 type 1 allergy/severe reaction, 4 without reaction (mislabelled) and 12 not documented. 37(80.4%) patients were treated previously with cephalosporins, whereas only 2 patients presented cross-reactivity. 30 (65.2%) patients met criteria to consider referring to PST, of which 67% had history of Pen-A >10 years ago, 60% required frequent antibiotic use,13% were immunosuppressed and 9% had infections caused by MDR bacteria.

Conclusion and relevance Most patients, around 80% would have been spared the use of BSA if the Pen-A label had been assessed. Furthermore, most patients who had received cephalosporins did not have cross-reactivity. The introduction of PST could help correctly verify Pen-A in 65.2% patients. Hereinafter, ED pharmacist will be prepared to evaluate possible Pen-A to reduce the use of BSA and de-label when necessary.

Conflict of interest No conflict of interest

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.