Pre-Operative Management of the Penicillin Allergic Patient: A Narrative Review

Area of Science:

• Infectious Disease
• Allergy and Immunology
• Orthopaedic Surgery

Background:

• Penicillin allergy is commonly reported, leading to avoidance of beta-lactam antibiotics like cephalosporins due to cross-reactivity concerns.
• This avoidance often results in the use of less effective antibiotics (e.g., clindamycin, vancomycin), increasing postoperative infection risk in joint and spine surgeries.
• True IgE-mediated hypersensitivity to penicillin is rare, yet the misconception impacts perioperative antibiotic selection.

Purpose of the Study:

• To review orthopaedic procedure outcomes in patients with reported penicillin allergies.
• To discuss challenges and solutions for perioperative care in penicillin-allergic patients.
• To highlight the benefits of preoperative penicillin allergy testing.

Main Methods:

• Literature review focusing on outcomes of orthopaedic procedures in patients with reported penicillin allergies.
• Analysis of studies investigating the efficacy of alternative antibiotics versus penicillin-based prophylaxis.
• Examination of data on the cost-effectiveness and impact of preoperative penicillin allergy testing.

Main Results:

• Using less effective antibiotics in penicillin-allergic patients increases the risk of postoperative infections in elective knee, shoulder, and spine surgeries.
• Preoperative penicillin allergy testing is a cost-effective strategy for preventing prosthetic joint infections.
• Accurate penicillin allergy assessment is crucial for appropriate perioperative antibiotic selection.

Conclusions:

• Misconceptions about penicillin allergy lead to suboptimal antibiotic choices and increased infection rates in orthopaedic surgery.
• Preoperative penicillin allergy testing should be considered for all penicillin-allergic patients undergoing surgery.
• Implementing accurate allergy assessment protocols can improve patient outcomes and reduce healthcare costs.