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Antibiotic Allergy Labels in Children Are Associated with Adverse Clinical Outcomes

Michaela Lucas¹, Annabelle Arnold², Aine Sommerfield³

¹Department of Clinical Immunology, Princess Margaret Hospital, Perth, WA, Australia; Faculty of Health and Medical Sciences, UWA Medical School, University of Western Australia, Perth, WA, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia; PathWest Laboratory Medicine, Perth, WA, Australia; Department of Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia.

The Journal of Allergy and Clinical Immunology. in Practice

|September 22, 2018

Insights

Antibiotic allergy labels in children are linked to increased use of alternative antibiotics and longer hospital stays. This study highlights the negative clinical impact of these labels in pediatric patients.

Area of Science:

Pediatric Allergy
Clinical Outcomes Research
Antimicrobial Stewardship

Background:

Self-reported antibiotic allergies are frequent in hospitalized children.
Limited research exists on the specific impact of antibiotic allergy labels in pediatric populations.

Purpose of the Study:

To determine the clinical outcomes associated with antibiotic allergy labeling in pediatric inpatients.
To investigate the relationship between antibiotic allergy labels and antibiotic prescribing patterns.

Main Methods:

Retrospective chart review of 1672 pediatric inpatient admissions from April 2014 and April 2015.
Data collection included documented antibiotic allergy labels, antibiotic prescriptions, and hospital length of stay.
Statistical analysis adjusted for patient age, sex, principal diagnosis, and admitting specialty.

Main Results:

Antibiotic allergy labels were present in 5.3% of pediatric patients, predominantly β-lactam allergies.
Patients with allergy labels received broader-spectrum antibiotics, including macrolides, quinolones, lincosamides, and metronidazole.
Children with antibiotic or β-lactam allergy labels experienced significantly longer hospital stays (mean 5.2 days vs. 3.8 days).

Conclusions:

This study provides the first evidence of negative clinical outcomes linked to antibiotic allergy labels in children.
Antibiotic allergy labels contribute to altered antibiotic selection and prolonged hospitalizations in pediatric care.

Read full analysis

Abstract

Background:

Self-reported antibiotic allergies are common among hospitalized adults and children. However, there is a paucity of studies investigating the impact of an antibiotic allergy label in childhood.

Objective:

To investigate the impact of antibiotic allergy labeling on clinical outcomes in children.

Methods:

A retrospective study was conducted in a major pediatric tertiary hospital to capture inpatient admissions (N = 1672) in April 2014 and April 2015. Data, collected by chart review, included documented antibiotic allergy labels, antibiotic prescriptions, admitting specialty, hospital length of stay, and hospital readmissions.

Results:

Of the 1672 pediatric patients surveyed, 58.1% were male and 44.8% were prescribed antibiotics. Antibiotic allergy labels were recorded in 5.3% of patients; most were β-lactam allergy labels (85%), mostly to unspecified penicillins. There was an increasing incidence of antibiotic allergy label with age, which was statistically significant (P < .001); no sex effect was seen. Patients with antibiotic allergy labels received more macrolide (P = .045), quinolones (P = .01), lincosamide (P < .001), and metronidazole (P = .009) antibiotics than did patients without an antibiotic allergy label. After adjusting for patient age, sex, principal diagnosis, and admitting specialty, children with any antibiotic or β-lactam allergy label had longer hospital stays (odds ratio, 1.62; 95% CI, 1.05-2.50; P = .03) with a mean length of hospital stay of 3.8 days for those without a label and 5.2 days for those with a β-lactam allergy label.

Conclusions:

This is the first study demonstrating the negative impact of antibiotic allergy labels on clinical outcomes in children, as evidenced by significant alternate antibiotic use and longer hospital stays.

Keywords:

Adverse reactions/hypersensitivity Antibiotic allergy labels Antimicrobial prescribing Pediatric drug allergy

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