Knowledge and Confidence of Physician Assistant Students in Managing Patients with a Documented Penicillin Allergy

Objective: Physician assistants (PAs) are frequently involved in managing acute bacterial infections in patients with documented penicillin (PCN) allergies. Inappropriate antibiotic choice in patients with existing allergies may place them at undue risk. This study aimed to assess the knowledge and confidence among PA students in managing patients with documented PCN allergies. Methods: An electronic survey was distributed to enrolled students in participating PA programs in North and South Carolina. The survey tool consisted of 20 questions with 13 focused on knowledge and confidence primarily scored on a 5-point Likert scale. Data were collected and protected via the REDCap^® database. Primary objectives were knowledge of penicillin allergies and confidence in management decisions. Sufficient knowledge was considered a score of 80% or greater; adequate knowledge was considered 70% or greater on relevant assessments. Results: Overall, 406 students from 10 unique programs completed the survey. They were predominantly female (76%) with 43% in the first year of their program. The mean student knowledge score was 25.9%, and 30% of respondents achieved adequate knowledge. Respondents reported an average cross reactivity between penicillin and beta-lactams of 29% (10-63%), cefazolin 50% (24-75), ceftriaxone 29% (11-60), and carbapenems 26% (8-50). The majority of respondents (66.5%) reported high levels of confidence in managing patients with penicillin allergies. Conclusions: The study found significant discordance between PA students' high level of confidence in assessing patients with a PCN allergy and their comparative knowledge. PA students are likely to avoid beta-lactam antibiotics when there is a documented penicillin allergy, regardless of the documented reaction or low likelihood of cross-reactivity. Further training and education will help to encourage appropriate prescribing in these high-risk patients.