Suspected penicillin allergy: risk assessment using an algorithm as an antibiotic stewardship project
- PDF / 381,621 Bytes
- 7 Pages / 595 x 842 pts (A4) Page_size
- 18 Downloads / 147 Views
Allergo J Int (2020) 29:174–180 https://doi.org/10.1007/s40629-020-00135-5
Suspected penicillin allergy: risk assessment using an algorithm as an antibiotic stewardship project Christiane Querbach · Tilo Biedermann · Dirk H. Busch · Rüdiger Eisenhart-Rothe · Susanne Feihl · Christiane Filser · Friedemann Gebhardt · Markus Heim · Helmut Renz · Kathrin Rothe · Christoph D. Spinner · Melanie Starzner · Christian Suren · Monika Trojan · Knut Brockow
Received: 29 April 2020 / Accepted: 18 June 2020 / Published online: 27 August 2020 © The Author(s) 2020
Summary Background Beta-lactam antibiotics (BLA) are the treatment of choice for a large number of bacterial infections. Putative BLA allergies are often reported by patients, but rarely confirmed. Many patients do not receive BLA due to suspected allergy. There is no systematic approach to risk stratification in the case of a history of suspected BLA allergy. Methods Using the available stratification programs and taking current guidelines into account, an algorithm for risk stratification, including recommendations on the use of antibiotics in cases of compellingly indicated BLA despite suspected BLA allergy, was formulated by the authors for their maximum care university hospital. Results The hospital is in great need of recommendations on how to deal with BLA allergies. Patientreported information in the history forms the basis for classifying the reactions into four risk categories:
(1) BLA allergy excluded, (2) benign delayed reaction, (3) immediate reaction, and (4) severe cutaneous and extracutaneous drug reaction. Recommendations strictly depend on this classification and range from use of full-dose BLA or use of BLA under certain conditions (e.g., two-stage dose escalation, non-crossreactive BLA only) to prohibiting all BLA and the use of alternative non-BLA. In case of suspected immediate or delayed allergic reactions, there is an additional recommendation regarding subsequent allergy testing during a symptom-free interval. Conclusion Triage of patients with suspected BLA is urgently required. While allergy testing, including provocation testing, represents the most reliable solution, this is not feasible in all patients due to the high prevalence of BLA allergies. The risk stratification algorithm developed for the authors’ hospital represents a tool suitable to making a contribution to rational antibiotic therapy.
C. Querbach · C. Filser · H. Renz · M. Starzner · M. Trojan Pharmacy Department, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
C. D. Spinner Department of Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
C. Querbach · D. H. Busch · S. Feihl · C. Filser · F. Gebhardt · M. Heim · H. Renz · K. Rothe · M. Starzner · M. Trojan Antibiotic Stewardship Unit, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
D. H. Busch · S. Feihl · F. Gebhardt · K. Rothe Institute for
Data Loading...
