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Documented Penicillin Allergies on Antibiotic Selection at Pediatric Emergency Department Visits

Eileen J Carter1, Katherine Zavez2, Steven C Rogers3

  • 1From the University of Connecticut School of Nursing, Storrs, CT.

Pediatric Emergency Care
|August 7, 2023
PubMed

Insights

Reported penicillin allergies in children significantly increase broad-spectrum antibiotic use. Delabeling these common, often inaccurate, allergies in pediatric emergency departments is a key antibiotic stewardship target.

Area of Science:

  • Pediatric Emergency Medicine
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Penicillin and amoxicillin are first-line treatments for common pediatric bacterial infections.
  • Reported penicillin allergies are frequent in children but often inaccurate.
  • The study investigates the impact of reported penicillin allergies on antibiotic selection in pediatric emergency departments.

Purpose of the Study:

  • To evaluate how reported penicillin allergies affect broad-spectrum antibiotic use in pediatric emergency department (ED) visits.
  • To assess the influence of reported penicillin allergies on antibiotic choice for acute otitis media (AOM) and group A streptococcus (GAS) pharyngitis.

Main Methods:

  • Retrospective cohort study of pediatric patients from 2014-2016 in a large pediatric ED.
  • Analysis of electronic medical records to identify patients with reported penicillin allergies.
  • Used generalized estimating equation and logistic regression models to analyze antibiotic selection and treatment probabilities.

Main Results:

  • 6.2% of 12,987 pediatric patients had a documented penicillin allergy.
  • Reported penicillin allergies were associated with a 13.55-fold increased odds of receiving broad-spectrum antibiotics.
  • Children with documented penicillin allergies had a 0.97 probability of receiving alternative treatments for AOM and GAS.

Conclusions:

  • Reported penicillin allergies significantly drive the use of broad-spectrum antibiotics in pediatric EDs.
  • Delabeling penicillin allergies, especially for acute respiratory infections, is a potential antibiotic stewardship intervention.
  • Targeting penicillin allergy "delabeling" can improve antibiotic prescribing practices in pediatric care.
Abstract

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