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The key to penicillin allergy delabeling

Tool KitsIn-Patient EvaluationOut-Patient EvaluationPre-Operative EvaluationAssessment of Children
BASICS PENICILLIN/
 BETA-LACTAM ALLERGYTerminologyWhat are the facts about penicillin allergy?What are the consequences of being labeled penicillin allergic?Cross-reactivity between beta-lactam anitbioticsIs PCN Allergy necessarily forever?What types of allergic reactions occur with PCN and beta-lactams?What is needed to clinically evaluate a patient with a reported PCN allergy?Can you do a risk stratification for beta-lactam allergic patients?How to manage a patient with a beta-lactam (PCN) allergy?Can cefalozin be given to PCN allergic patients for perioperative prophylaxis?How can we delabel children with a penicillin allergy
BIBLIOGRAPHYReview ArticlesReferences

Consequences of being labeled as PCN allergic

Use of an alternative antibiotic can result in:

  • More treatment failures/suboptimal treatment
    • Vancomycin treatment of methicillin – sensitive Staphylococcus aureus bacteremia (increased failure rate and relapses) (3)
    • Gram negative bacteremia (increased treatment failure when treated with a non-beta-lactam antibiotic) (4)
  • Adverse effects
    • Increased rates of Clostridiodes difficile
    • Vancomycin nephrotoxicity
  • Contribute to development of antimicrobial resistance
    • Increased MRSA and vancomycin resistant enterococcus healthcare-associated infections
  • Increased use of carbapenems (5)
  • Increased length of stay (LOS) with associated increased costs
    • Antibiotic costs are 63% to 158% higher for those with reported PCN allergy than those not allergic to PCN (6)
  • Increased surgical site infection (SSI) risk
    • Patients with reported PCN allergy had a 51% increased risk of developing a SSI primarily related to the substitution of non-beta-lactam prophylactic antibiotics for cephalosporins (7) (8)