Penicillin Allergy label - the unmet needs - causes and potential solutions

Area of Science:

• Clinical Medicine
• Pharmacology
• Infectious Diseases

Background:

• Penicillin allergy is the most common drug allergy, with overdiagnosis leading to significant negative consequences.
• Consequences of penicillin allergy overdiagnosis include inappropriate antibiotic prescribing, increased antimicrobial resistance, worse clinical outcomes, and elevated healthcare costs.

Purpose of the Study:

• To audit current inpatient practices for diagnosing, investigating, documenting, and managing penicillin allergy against NICE Clinical Guidance 183 (CG183).
• To survey junior doctors on barriers to implementing NICE CG183 and explore potential solutions for improving penicillin allergy management.

Main Methods:

• An audit of 403 inpatients' records was conducted based on NICE CG183 criteria.
• A survey of 50 junior doctors assessed their knowledge, confidence, and perceived barriers regarding NICE CG183 guidelines.
• Exploration of junior doctors' views on solutions to improve penicillin allergy diagnosis and de-labelling practices.

Main Results:

• 13% of patients were labeled penicillin allergic, with 24% meeting referral criteria but none referred.
• Documentation of penicillin allergy details was significantly lacking, with major omissions in drug name, reaction severity, and administration route.
• Barriers identified by junior doctors included lack of awareness and confidence in NICE CG183, and a tendency to avoid de-labelling.

Conclusions:

• Current penicillin allergy diagnosis, documentation, and management practices are suboptimal and do not align with NICE CG183.
• Insufficient awareness and confidence in applying NICE CG183 guidelines are key barriers to best practice.
• Decision support tools, such as a drug allergy app, are recommended to overcome these barriers and facilitate appropriate penicillin allergy de-labelling.