Rationalizing antibiotic prescribing for bacterial pneumonia in patients with reported penicillin allergy-a
Xer Min Nicole Lau1, Xinle Zhu1, Dylan Sidhu1
1National University of Singapore, Yong Loo Lin School of Medicine, 10 Medical Dr, Singapore 117597, Singapore.
Background:
Penicillin allergy is commonly reported, yet often mislabelled. Such a label is associated with adverse outcomes in bacterial pneumonia. Despite recognition of the overlabelling of penicillin allergy and the awareness of potential adverse effects, there are limited data on the rationale for the management of patients with bacterial pneumonia and concomitant penicillin allergy.
Objectives:
To investigate the rationale guiding antibiotic prescription for bacterial pneumonia patients with reported penicillin allergy to improve outcomes.
Methods:
Semi-structured interviews were conducted between May and September 2022 to explore the management of patients with bacterial pneumonia and concomitant penicillin allergy. Data were analysed thematically using NVivo software. Recruitment was stopped when thematic saturation was reached.
Results:
Twenty doctors from the National University Hospital System, Singapore were interviewed. Role models and guidelines were found to be important in helping junior doctors make appropriate prescribing decisions. The ease of accessibility of detailed descriptions in allergy records and allergy services were among the concerns raised.
Conclusions:
Locally adapted approaches can be taken to appropriately label and delabel penicillin allergy, optimizing treatment and outcomes for patients with pneumonia and other common infectious diseases. We found that in an Asian urban context, role models and guidelines have been helping junior doctors make appropriate prescription decisions. More resources may be channelled into delabelling penicillin allergy to optimize patient outcomes.
Insights
Penicillin allergy is often mislabelled, impacting bacterial pneumonia treatment. Focusing on accurate allergy assessment and delabeling can improve patient outcomes and antibiotic prescribing.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Medical Education
Background:
- Penicillin allergy is frequently reported but often inaccurately labeled, leading to adverse outcomes in bacterial pneumonia patients.
- Despite awareness of penicillin allergy overlabeling and its consequences, the rationale for managing these patients remains under-researched.
Purpose of the Study:
- To explore the decision-making process behind antibiotic prescriptions for bacterial pneumonia patients with reported penicillin allergies.
- To identify strategies for improving antibiotic selection and patient outcomes in this population.
Main Methods:
- Semi-structured interviews were conducted with 20 doctors in Singapore between May and September 2022.
- Thematic analysis using NVivo software was employed to analyze the interview data until thematic saturation was achieved.
Main Results:
- Junior doctors rely on role models and clinical guidelines for appropriate antibiotic prescribing decisions.
- Concerns were raised regarding the accessibility of detailed allergy information and the availability of allergy services.
Conclusions:
- Implementing locally tailored strategies for penicillin allergy labeling and delabeling can optimize treatment for pneumonia and other infections.
- Investing in penicillin allergy delabeling initiatives is crucial for enhancing patient outcomes, particularly in Asian urban healthcare settings.
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