Penicillin reintroduction using the PEN-FAST score reduces infectious complications in maxillofacial surgery

Self-reported penicillin allergy frequently limits optimal antibiotic prescribing in maxillofacial surgery. The PEN-FAST score (Penicillin allergy, within the last five years, Anaphylaxis/angioedema, Severe cutaneous adverse reaction, Treatment required for allergy episode) is a validated clinical decision rule used to identify patients at low risk of true penicillin allergy and to guide safe penicillin reintroduction.

We conducted a prospective, interventional, single-center study including adult patients with a self-reported penicillin allergy undergoing maxillofacial surgery. A PEN-FAST score was calculated for each patient. Penicillins were reintroduced in patients classified as very low risk (PEN-FAST = 0). Primary outcomes were adverse reactions and infectious complications. Secondary outcomes included surgical site infection (SSI), severe infectious complications (SIC), length of hospital stay, and number of surgical interventions.

Seventy-four patients were included, of whom 41 (55%) had a PEN-FAST score of 0. Penicillins were reintroduced in 29 of these patients (71%), with no adverse reactions observed. In multivariate analysis, penicillin non-use was independently associated with a higher risk of SSI or SIC (odds ratio [OR] = 31.54, 95% CI [5.422-611.72]; p = 0.002). Penicillin non-use was also associated with prolonged hospital stay (incidence rate ratio [IRR] = 1.86, 95% CI [1.13-3.00]; p = 0.012) and an increased number of surgical interventions (IRR = 1.41, 95% CI [1.08-1.88]; p = 0.018) after stratification by type of surgery.

Penicillin reintroduction guided by the PEN-FAST score is safe in very low-risk patients and is associated with improved clinical outcomes. Routine implementation of this tool in maxillofacial surgery may reduce infectious complications and healthcare utilization.