Single-Shot Perioperative Antibiotic Prophylaxis in Patients With a History of Penicillin Allergy: An Algorithm for...

Patients with a history of penicillin allergy are often given a less suitable non-ß-lactam antibiotic as single-shot peri - operative prophylaxis, for fear of an allergic reaction. This endangers these patients' health, particularly exposing them to a higher risk of wound infection.

With the aid of a quality management tool and three iterative "Plan-Do-Study-Act (PDSA)" cycles, we developed and evaluated an algorithm for the safe administration of single-shot cefuroxime as perioperative antibiotic prophylaxis in patients with a history of penicillin allergy.

6045 anesthesia records were evaluated in three PDSA cycles. 340 patients (5.6%) reported a penicillin allergy in their medical history, and 166 of these patients (2.7% of the total) received perioperative antibiotic prophylaxis: 156 (2.5%) patients were given cefuroxime, and 7 (0.1%) were given another antibiotic, mainly for surgery-specific reasons. In two cases, clindamycin was given despite the algorithm; these two led to quality improvement measures, so that in the third PDSA cycle, over an observation period of 6 months, no patient was denied cefuroxime because they had a penicillin allergy. No allergic reactions to cefuroxime were observed.

As part of a quality management measure, we developed an algorithm that allowed cefuroxime to be given as single-shot perioperative antibiotic prophylaxis to almost all patients with a history of penicillin allergy. Only patients with severe T-cell-mediated reactions should not be given ß-lactam antibiotics.