A survey of antibiotic prescribing and knowledge of penicillin allergy

Cephalosporins can cause allergic reactions in patients with penicillin (PCN) allergy. Physicians' prescribing habits for patients with PCN allergy can vary.

1) Survey community and academic physicians, students, residents, and allergists on their tendencies to prescribe cephalosporins and/or perform PCN skin testing in patients with different histories of PCN allergy. 2) Evaluate PCN allergy knowledge in these groups.

A questionnaire consisting of four case scenarios and five true/false questions on PCN allergy was distributed at various conferences and by mailings.

Three hundred seventy-eight completed surveys were analyzed. Given a patient with a history of rash with PCN, an equal number of allergists and nonallergists (36%) prescribed cephalosporins, although there was a difference between pediatricians (56%) and internists (22%). Given a history of PCN anaphylaxis, no allergists but 11% of nonallergists prescribed a cephalosporin. Skin testing was infrequently requested by nonallergists. The correct response rate for the true/false questions was 89% for allergists, community (63%) and academic (67%) physicians, pediatricians (61%), internists (67%), residents (68%), and students (68%). Pediatric residents had the highest (74%) and community pediatricians the lowest (59%) correct response rate.

There is marked variation in prescribing cephalosporins and in requesting PCN skin testing in patients with varied histories of PCN allergy. The survey results indicate a need for increased PCN allergy education.