SOP’s Heil Leads Study Showing Penicillin Testing Can Change Treatment Course

Eighty percent of patients were able to switch to more effective therapy.

By Patricia Fanning
August 17, 2016

A new study from the University of Maryland reveals that testing hospital patients for penicillin allergy leads to optimal antibiotic treatment, since most people who think they are allergic to penicillin are actually not.¹  And finding out doesn’t take an allergist: the study evaluated a penicillin allergy skin testing program that was managed by infectious diseases physician fellows who were able to appropriately assess patients for penicillin allergy and perform the testing.

“Our study confirmed that many people who think they have a penicillin allergy actually do not when penicillin allergy testing is performed,” says Emily L. Heil, PharmD, BCPS-AQ ID, lead author of the study and assistant professor in the Department of Pharmacy Practice and Science (PPS) at the University of Maryland School of Pharmacy.  “This is hugely important since patients with reported penicillin allergies tend to get suboptimal antibiotic therapy compared to patients without reported penicillin allergies.”

Treatment can be improved as a result of penicillin allergy testing according to the study:

• 84% of those who tested negative for penicillin allergy were given antibiotic changes
• 63% received a narrower spectrum antibiotic
• 80% received more effective therapy
• 61% received more cost effective therapy

Skin testing was conducted on 76 people who said they were allergic to penicillin while they were patients at the University of Maryland Medical Center.  Of the valid tests, 96 percent were negative (not allergic), according to the study published in July 2016 in Open Forum Infectious Diseases, a peer-reviewed journal from Oxford University Press.

The outcome mirrors the results of several national studies that have led the U.S. Centers for Disease Control and Prevention (CDC) to alert healthcare professionals to implement specific interventions, such as a penicillin allergy assessment protocol, to improve antibiotic use at the hospital. ²

Heil and colleagues, who include several researchers from the University of Maryland School of Medicine, conducted a study to assess the feasibility of a penicillin allergy skin testing service managed by physicians in the Infectious Diseases Fellowship Program.   Fellows received education and training in penicillin allergy testing, then consulted with various hospital departments to select patients for assessment and to undergo skin testing.

Training infectious diseases fellows proved to be a “great resource,” Heil says, since many allergists work only in outpatient settings and do not see patients in hospitals.  In fact, a national survey of infectious disease specialists, conducted by the University of Maryland, indicates that lack of time and inadequate personnel are the main barriers to penicillin skin testing. Yet, those surveyed note that penicillin allergy is often overstated and affects antibiotic choice, so teaching infectious disease fellows how to evaluate and test for penicillin allergy could enhance patient care and cost savings, Heil notes.

“For other institutions without access to inpatient allergist services, infectious diseases physicians can help provide this important service,” Heil notes.

For more information on the University of Maryland study visit: http://ofid.oxfordjournals.org/content/early/2016/07/22/ofid.ofw155.abstract.

 

^{1 Implementation of an Infectious Disease Fellow Managed Penicillin Allergy Skin Testing Service, Open Forum Infectious Diseases July 22, 2016, http://ofid.oxfordjournals.org/content/early/2016/07/22/ofid.ofw155.abstract}

^{2 Antibiotic Stewardship in Acute Care: A Practical Playbook, U.S. Centers for Disease Control and Prevention (CDC), 2016.}

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