Penicillin Allergy Evaluation Pathway in a Community-Based Obstetric Setting: A Quality Improvement Study

The objective of this study was to increase completion of penicillin allergy evaluation among pregnant patients and assess its impact on antibiotic utilization and safety.

This quality improvement initiative was conducted across Mayo Clinic Health System obstetric departments in southeast Minnesota from September 12, 2023, through February 15, 2025. Pregnant patients with a reported penicillin allergy presenting for prenatal care were included. The intervention consisted of standardized screening, referral, and Allergy and Immunology-led evaluation, including skin testing and oral challenge. The primary outcome was completion of penicillin allergy evaluation. Secondary outcomes included antibiotic utilization and adverse events. Statistical comparisons were performed using χ² or Fisher's exact tests, with significance defined as p < 0.05.

Among 120 eligible patients, 56 (46.7%) completed evaluation, 24 (20.0%) had incomplete evaluation, and 40 (33.3%) declined. Of those completing evaluation, 49 (87.5%) were delabeled. β-lactam antibiotic use was significantly higher in the evaluation-complete group compared with the noncompleted group (96.6% vs 77.5%; p = 0.037). Among patients with group B Streptococcus positivity undergoing vaginal delivery, penicillin use was 90.9% in the evaluation-complete group compared with 0.0% in the noncompleted group (p < 0.001). Adverse reactions occurred in 4 patients and were mild and self-limited.

Implementation of a structured penicillin allergy evaluation pathway in a community-based obstetric setting was feasible, safe, and associated with significant improvements in guideline-concordant antibiotic use.