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

E Bouillien1, Q Hennocq1, J P Foy1

  • 1Sorbonne Université, Department of Maxillo-Facial Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris, Paris, France.

Journal of Stomatology, Oral and Maxillofacial Surgery
|February 5, 2026
PubMed
Abstract

Insights

The PEN-FAST score safely identifies patients at low risk for penicillin allergy in maxillofacial surgery. Reintroducing penicillin in these patients improved outcomes and reduced complications.

Area of Science:

  • Maxillofacial Surgery
  • Clinical Decision Rules
  • Infectious Disease Management

Background:

  • Self-reported penicillin allergy is a common barrier to optimal antibiotic selection 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 tool to assess true penicillin allergy risk.

Purpose of the Study:

  • To evaluate the safety and efficacy of penicillin reintroduction in maxillofacial surgery patients identified as very low risk by the PEN-FAST score.
  • To assess the impact of penicillin non-use on infectious complications and healthcare utilization.

Main Methods:

  • Prospective, interventional, single-center study of adult patients with self-reported penicillin allergy undergoing maxillofacial surgery.
  • PEN-FAST score calculation for all patients; penicillin reintroduction for those with a score of 0.
  • Primary outcomes: adverse reactions and infectious complications. Secondary outcomes: surgical site infection (SSI), severe infectious complications (SIC), length of stay, and number of surgical interventions.

Main Results:

  • Of 74 patients, 41 (55%) had a PEN-FAST score of 0. Penicillin was safely reintroduced in 29 of these patients (71%) with no adverse reactions.
  • Penicillin non-use was independently associated with a significantly higher risk of SSI or SIC (OR=31.54, p=0.002).
  • Penicillin non-use correlated with prolonged hospital stay (IRR=1.86, p=0.012) and increased surgical interventions (IRR=1.41, p=0.018).

Conclusions:

  • Penicillin reintroduction guided by the PEN-FAST score is safe and effective for very low-risk patients in maxillofacial surgery.
  • Implementing the PEN-FAST score can potentially decrease infectious complications and reduce healthcare resource utilization.
  • This approach supports optimizing antibiotic prescribing and improving patient outcomes in this surgical population.
Keywords:
Drug allergyMaxillofacial surgeryPEN-FASTPenicillinSurgical site infection

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