• Overuse of broad-spectrum antibiotics leads to development and spread of multiple drug-resistant bacteria4
  • Overall added cost due to antibiotic-resistant organisms in U.S. is estimated at $26 billion ( i )

Antimicrobial Stewardship

By some estimates, up to half of all hospitalized patients in the US receive antibiotics and up to half of antimicrobial use may be inappropriate5. There is a causal relationship between inappropriate antimicrobial use and resistance; changes in antimicrobial use lead to parallel changes in the prevalence of resistance6. The CDC has recommended a more judicious use of available antibiotic agents and one way to accomplish this is may be to identify patients who have been erroneously labeled as penicillin allergic. Penicillin allergy testing can be a safe and effective strategy to reduce the use of broad spectrum antibiotics and can help modify antibiotic selection.7

  • Up to 25% of patients self-report having an allergy to at least one antimicrobial with penicillin as the most common, followed by sulfonamides, erythromycin and cephalosporin. However, most patients do not reliably describe themselves as being "allergic" as most reactions are not immunologic in nature. Despite the lack of reliable evidence, once an allergy label is entered into a patient's medical record, it will most likely remain there for the rest of the patient's life unless action is taken to verify that label( iv ).

Patient Care

Having a label of antibiotic allergy can lead to the withholding of guideline recommended antimicrobial therapies. One study found that 30% of patients labeled as allergic to at least one antimicrobial received antibiotic therapy that did not reflect the standard of care( v ). Often, alternative therapies may be less effective and have less favorable safety profiles, leading to treatment complications and increased risk of resistance( vi ). Patients reporting as penicillin allergic will often be placed on regimens of alternative antibiotic therapy, like fluoroquinolones and vancomycin. In fact, In-patients who report as penicillin allergic are more than twice as likely to be given vancomycin and up the three times as likely to receive flouroquinolones. The use of vancomycin as a second-line agent when patients are labeled as penicillin allergic is associated with colonization and infection with vancomycin resistant enterococci( vii ).

  • The mean antibiotic cost for patients allergic to penicillin is 63% higher than for those not allergic to penicillin( viii ).

Physician Tools

Recent studies have shown that antibiotics make up nearly 11.5% of total hospital drug costs( ix ). Since over half of all hospitalized patients are treated with at least one antibiotic the public health burden of incorrect drug allergy labels can significantly impact an already overburdened system. As medical costs continue to rise, improved drug cost management becomes more important to the long-term health of the medical system. The cost of purchase and administration of penicillin alternatives can be much higher than beta-lactam antibiotic choices due to the additional lab work required, nurse time, management of side-effects and longer lengths of hospital stays( x ).

  • 4Arroliga, Mercedes, Pien, Lily. Penicillin Allergy: Consider Trying Penicillin Again. Cleveland Clinic Journal of Medicine. Volume 70. Number 4. April 2003
  • 5Owens, RC Jr., Fraser GL, Stogsdill P et al. Antimicrobial Stewardship Programs as a Means to Optimize Antimicrobial Use. Insights from the Society of Infectious Disease Pharmacists. Pharmacotherapy. 2004;24:896-908
  • 6Dellit, TH, Owens, RC, McGowan JE, Jr et al. Infectious Disease Society of America and the Society for Healthcare Epidmiology of America Guidelines for Developing Institutional Programs to Enhance Antimicrobial Stewardship. Clin Infect Dis. 2007;44-150-77
  • 7Arroliga, Mercedes, Pien, Lily. Penicillin Allergy: Consider Trying Penicillin Again. Cleveland Clinic Journal of Medicine. Volume 70. Number 4. April 2003
  • i. Alliance for Prudent Use of Antibiotics and Cook County Hospital in Chicago
  • ii. Owens, RC Jr., Fraser GL, Stogsdill P et al. Antimicrobial Stewardship Programs as a Means to Optimize Antimicrobial Use. Insights from the Society of Infectious Disease Pharmacists. Pharmacotherapy. 2004;24:896-908
  • iii. Dellit, TH, Owens, RC, McGowan JE, Jr et al. Infectious Disease Society of America and the Society for Healthcare Epidmiology of America Guidelines for Developing Institutional Programs to Enhance Antimicrobial Stewardship. Clin Infect Dis. 2007;44-150-77
  • iv. Charneski, Lisa, PharmD., et al. Impact of the Antimicrobial Allergy Label in the Medical Record on Clinical Outcomes in Hospitalized Patients. Pharmacotherapy, Sept. 8, 2011;93(8):742-747
  • v. Lutomski DM, LaFollette JA. et al. Antibiotic Allergies in the Medical Record: Effect on Drug Selection and Assessment of Validity. Pharmacotherapy 2008;28: 1348 - 53
  • vi. Lee CE. et al. The Incidence of Antimicrobial Allergies in Hospitalized Patients. Arch Internal Med 2000;160:2819 - 22
  • vii. Boyce JM. et al. Controlling Vancomycin-Resistance Enterococci. Infect Control Hosp Epidemiol 1995;16:634-7
  • viii. Park, Miguel. et al. Diagnosis and Management of Penicillin Allergy. Mayo Clin Proc. March 2005; 800 (3): 405-410
  • ix. Charneski, Lisa, PharmD., et al. Impact of the Antimicrobial Allergy Label in the Medical Record on Clinical Outcomes in Hospitalized Patients. Pharmacotherapy, Sept. 8, 2011;93(8):742-747
  • x. Sade, K. et al. The Economic Burden of Antibiotic Treatment of Penicillin Allergic Patients in Internal Medicine Wards of a General Tertiary Care Hospital. Clin Exp Allergy 2003;33:501-6