FCAAIA Notes: Penicillin is still the drug of choice for some infections. It is inexpensive and has a relatively narrow spectrum of anti-bacterial coverage. It is estimated that up to 95% of people who are labelled “penicillin allergic” are actually allergic. Some were never allergic in the first place and were labelled so incorrectly. Of those who were truly allergic, 90% out-grow their allergy in about 10 years.
Are you allergic to penicillin (or not)? What happened when you took the antibiotic? See your allergist and get tested for penicillin if indicated. If you are not allergic to penicillin, it does not mean you have to take it, but most importantly, it means you do not need to avoid it.
See the article “Testing Penicillin Allergy Cuts Wide-Spectrum Antibiotic Use” also posted today.
(Source: http://www.medscape.com/viewarticle/871965?nlid=110789_3821&src=WNL_mdplsfeat_161122_mscpedit_aimm&uac=112079PK&spon=38&impID=1239786&faf=1 Nov. 22, 2016. For Medscape articles: User name: FCAAIA, Password: Allergies)
Providers of inpatient care who have prescribing authority have a poor understanding of when to consult an allergist about penicillin allergies, according to results from a new survey.
Despite acknowledging the need for allergy consultation in clinical scenarios, only 20% of respondents were able to judge when a patient would need a consultation with an allergist, and 42% did not know that penicillin allergy can resolve over time.
“You can’t know what you aren’t taught,” said lead investigator Allison Ramsey, MD, from the University of Rochester School of Medicine and Dentistry in New York.
“I don’t think this is emphasized in training; a teaching gap has led to a knowledge gap,” she told Medscape Medical News.
One of the problems is that there are not enough allergists to promote testing, she pointed out.
Research shows that although 10% of inpatients claim to have a penicillin allergy, only about 10% of those show an intolerance on testing, and even fewer are actually allergic,as reported by Medscape Medical News. Without testing, patients are unnecessarily given broad-spectrum second-line antibiotics.
A better understanding of penicillin-allergic patients would help improve antibiotic stewardship in hospitals, said Dr Ramsey.
“You want to save your powerful antibiotics for when they’re really needed,” she explained. “From a specialty perspective, this is an area where we as allergists can seize this opportunity and become an important resource.”
Results from a survey of prescribers at Rochester Regional Health were presented here at the American College of Allergy, Asthma & Immunology 2016 Annual Scientific Meeting.
From February to April of this year, 276 respondents from various levels of training and specialties answered 15 questions about the penicillin-allergic patient.
The majority of respondents were advanced practice providers (45%) or attending physicians (46%). Of the other 9% who were residents, 43% specialized in internal medicine, 20% in an internal medicine subspecialty, 12% in pharmacy, 7% in ob/gyn, and 18% in surgery.
All respondents showed an overall lack of knowledge, the investigators report.
When asked what percentage of patients with a reported penicillin allergy will tolerate penicillin, only 30% of respondents knew the correct answer, which is 90%.
“If a drug is on the allergy list, most providers are just going to avoid it,” Dr Ramsey said. “But we know that only about 10% actually have an allergy. They should consult us for testing to make sure. That’s not happening right now.”
When asked about consulting an allergist or immunologist, 80% of attending providers and advanced practitioners reported that they never do, or do so only once a year, even though, when provided two hypothetical clinical scenarios, they reported that they would.
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