Intracameral Cefuroxime Use in Cataract Surgery After Penicillin Allergy Reclassification

Area of Science:

• Ophthalmology
• Infectious Diseases
• Health Policy

Background:

• Penicillin allergy labels are common in patients undergoing cataract surgery, yet true allergies are infrequent.
• Limited cephalosporin cross-reactivity concerns exist, but clear antibiotic selection guidance for these patients is lacking.

Purpose of the Study:

• To evaluate the impact of a penicillin allergy label reclassification policy on perioperative antibiotic selection during cataract surgery.

Main Methods:

• A quality improvement study analyzed 1905 patients with penicillin allergy labels undergoing cataract surgery over five years.
• The intervention involved enhanced pharmacy collaboration, suppressed electronic alerts, and allergy reclassification, implemented in November 2022.

Main Results:

• Post-intervention, cefuroxime use increased significantly to 71% from 2% after adjustment, exceeding the expected rate.
• The adjusted odds ratio for cefuroxime use decreased post-intervention (0.37), particularly for high-risk allergies before pharmacist review.

Conclusions:

• Evidence-based antibiotic selection policies can improve appropriate cefuroxime use in cataract surgery for patients with penicillin allergy labels.
• The observed increase in cefuroxime use highlights the potential benefits of surgeon education and pharmacy support.