Non–beta-lactam allergy not nearly as common as reported, study finds
A study of Australian children has found that only 1 in 5 with a reported non–beta-lactam antibiotic (NBLA) allergy had a true allergy, Australian researchers reported today in Pediatrics.
The retrospective study looked at children ages 0 to 18 at a tertiary pediatric hospital in Melbourne who had a suspected NBLA allergy and who had a skin test or intravenous or oral challenge test from May 2011 through June 2018. Over the course of the 7-year study period, 141 children had 150 evaluations of 15 different NBLAs, with a median time from the initial reported reaction to allergy evaluation of 1.9 years.
Overall, 27 of the 150 challenge results for NBLAs (18%) were positive. The frequency of reported reactions was highest for trimethoprim-sulfamethoxazole (15 of 46, 32.6%) and macrolides (8 of 77, 10.4%). Of the challenges that had positive results, most (23 of 27, 85.2%) had symptoms on repeat challenge that were similar to those initially reported. Four children reported initial anaphylactic reactions, but none had severe reactions on re-challenge or required adrenaline.
The authors of the study say the findings indicate that 80% of children with a reported NBLA allergy could be de-labeled, which could help preserve first-line antibiotics for these patients. They also note that while the median time to allergy evaluation was 1.9 years, delay in confirmation or exclusion of an NBLA allergy extended up to 14.9 years. They recommend that testing should occur promptly after an initial reaction.
"Improved access to standardized and reliable allergy testing protocols to delabel children are urgently needed," they conclude.
Dec 3 Pediatrics abstract
Study touts benefits of reviewing antibiotics for discharged patients
A single-center study in Infection Control and Hospital Epidemiology highlights discharge antibiotic review as a potential stewardship tool.
The study examined a 19-month period (June 2017 to December 2018) during which the antibiotic stewardship team at an 87-bed Veterans' Affairs hospital in Wisconsin reviewed the electronic health records of patients discharged from the hospital with oral antibiotics for appropriateness of antibiotic drug choice, duration, and dosing.
Because of limited resources, reviews were conducted only twice weekly, sometimes 3 to 4 days after patients had been discharged. Interventions recommended by the stewardship team included antibiotic discontinuation; change of antibiotic, dose, or duration; and diagnostic testing. Verbal and/or written recommendations were made to the prescribing service and, in some cases, the pharmacist.
Overall, 929 patients were discharged with antibiotics during the study period, and the stewardship team suggested changes in 90 prescriptions (9.7%). The most common reasons for intervention were antibiotic not indicated (43.3%), incorrect duration of therapy (24.4%), and preferred alternate antibiotic could have been chosen (23.3%). In 52 of the 90 interventions, the intervention was unable to be acted upon because the antibiotic course had already been completed; of the remaining 38 interventions, 22 (57.9%) were accepted by providers.
Common disease states intervened upon were chronic obstructive pulmonary disease (COPD, 24.4%), urinary tract infection (UTI, 18.8%), pneumonia (15.5%), and skin and other soft-tissue infection (SSTI, 15.5%).
The authors of the study note that while prescribers appeared to welcome feedback and suggestions on prescribing, the low acceptance rate could indicate increased barriers to intervention that are unique to discharged patients. Going forward, they suggest that focusing discharge stewardship interventions on common conditions like COPD, UTI, pneumonia, and SSTI may increase review efficiency, and that performing reviews prior to discharge could have a greater impact on patient care.
Nov 29 Infect Control Hosp Epidemiol abstract
