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Description of a pharmacist-managed/administered penicillin allergy skin testing service at a community hospital
Nicholas P Torney1, Michael D Tiberg2
1Munson Medical Center, Traverse City, MI, USA.
Insights
A pharmacist-led penicillin allergy skin testing (PAST) service successfully transitioned 84.4% of patients to preferred beta-lactam antibiotics. This antimicrobial stewardship initiative reduced the need for more toxic and costly alternative medications.
Area of Science:
- Pharmacology
- Infectious Diseases
- Hospital Pharmacy
Background:
- Penicillin allergy is frequently reported but often unconfirmed, leading to broad-spectrum antibiotic use.
- Unnecessary avoidance of beta-lactam antibiotics can result in suboptimal treatment and increased healthcare costs.
Purpose of the Study:
- To describe the integration of a pharmacist-managed penicillin allergy skin testing (PAST) service within a hospital's antimicrobial stewardship program.
- To evaluate the effectiveness of pharmacist-administered PAST in improving antibiotic selection.
Main Methods:
- A pharmacist-managed PAST service was implemented for patients with a history of penicillin allergy.
- Inclusion criteria focused on type I or unknown reactions older than 5 years; exclusion criteria included pregnancy or recent antihistamine use.
- The primary outcome measured was the transition rate to preferred beta-lactam antibiotics post-testing.
Main Results:
- Ninety patients underwent PAST between October 2015 and December 2019, with 94% completing the service.
- A significant majority (84.4%) were successfully transitioned to preferred beta-lactams.
- This transition avoided 1,568 days of alternative antibiotic use, with a median of 11 days per patient.
Conclusions:
- Pharmacist-led PAST services are effective in optimizing antimicrobial therapy within hospital settings.
- Integrating PAST into antimicrobial stewardship programs enhances the use of preferred, less toxic, and more cost-effective antibiotics.
Purpose:
To describe how a pharmacist-managed and pharmacist-administered penicillin allergy skin testing (PAST) service was incorporated into an antimicrobial stewardship program at a community hospital.
Methods:
A pharmacist-managed/administered PAST service was initiated in October 2015. Patients 18 years of age or older were considered for PAST if they had a reported history of a type I or unknown type of allergic reaction to penicillin that occurred more than 5 years previously. Patients with a vague allergy history were considered for PAST if the provider was uncomfortable prescribing a preferred β-lactam out of concern for penicillin allergy. Patients were excluded if they were pregnant, had a history of a non-type I allergic reaction, or recently received antihistamines. The primary outcome was the percentage of patients who underwent PAST and were subsequently transitioned to a preferred β-lactam.
Results:
PAST was initiated in 90 patients from October 2015 to December 2019. Eighty-five out of 90 patients (94%) completed PAST. Seventy-six out of 90 patients (84.4%) who underwent PAST were transitioned to a preferred β-lactam. The most commonly administered antibiotics prior to PAST were vancomycin, cefepime, and metronidazole. The most commonly used antibiotics after PAST were penicillin, piperacillin/tazobactam, and ampicillin/sulbactam. Among the 90 patients who underwent PAST, alternative antibiotics were avoided for a total of 1,568 days, with a median of 11 days (interquartile range, 6-18 days) avoided per patient.
Conclusion:
Incorporating a pharmacist-managed/administered PAST service into a community hospital's antimicrobial stewardship program can improve the utilization of preferred antimicrobial therapy and help avoid use of more toxic, costly antimicrobials.
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