Penicillin allergy testing can be performed safely on hospitalized patients and suggests improved outcomes, less vancomycin use, and potential cost savings.1

Download PDF: Penicillin Skin Testing Overview

Download PDF: Implementation Specialist Support Guide

Penicillin Skin Testing Overview

Approximately 10% of the general population and up to 20% of hospitalized patients claim an “allergy” to penicillin; however, the majority of these patients are not truly allergic when assessed by skin testing.

  • In an era of rising antibiotic costs and growing antibacterial resistance, a patient’s uncertain allergy history can force a prescriber to choose a drug that may not be optimal.2
  • Carrying an inaccurate diagnosis of penicillin ‘‘allergy’’ could adversely affect the quantity and quality of health care used.1
  • Penicillin allergy skin testing improved access to the most appropriate antibiotics without having a negative impact on patient safety or outcomes.3

Implementing penicillin allergy skin testing in your facility may bring the following benefits:

Combating Drug Resistance

  • Drug allergy history is associated with increased hospital use over the next several years and significantly higher rates of serious infections.3
  • Recent studies state, patients claiming a penicillin allergy (compared to the control subjects) had1


Higher Incidence of C. difficile


Higher Incidence of MRSA


Higher Incidence of VRE Infections

  • Current literature supports the role of penicillin allergy skin testing within various practice settings as an intervention for improving patient care by reducing the use of alternative antibiotics.3
  • Antibiotic-resistant infections cost the US Healthcare system in excess of $20 billion annually, as reported by the Alliance for the Prudent Use of Antibiotics.4

Reduction in Cost

  • A recent study by King et al where most subjects were receiving high-cost broad-spectrum agents found a difference in mean daily antibiotic cost of $297 per patient after testing.5
  • Penicillin skin testing is the most rapid, sensitive, and cost-effective modality for evaluating patients with immediate allergic reactions to penicillin.6

Antimicrobial Stewardship Support

  • The increased use of penicillin skin testing may help improve antibiotic stewardship in the hospital setting.6
  • Penicillin skin testing may serve as a novel tool preserving provider autonomy in antibiotic prescribing and breaking down barriers to using preferred therapeutic agents, including B-lactams, if clinically indicated.3
  • Penicillin allergic patients are significantly more likely to receive fluoroquinolones, vancomycin, and clindamycin than non-allergic patients.1

Introduction of penicillin allergy skin testing may allow trained healthcare providers to prescribe less expensive, more appropriate, less toxic antimicrobial agents.

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help you impact antibiotic treatment
through penicillin allergy testing.

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  • 1Macy, Eric, et al. Health Care Use and Serious Infection Prevalence Associated with Hospitalized Patients. JACI. Vol. 133, No. 3. March 2014.
  • 2Wall, Geoffery, et al. Pharmacist-managed service providing penicillin allergy skin tests. Am J Health-Syst Pharm. Vol 61. Jun 2004.
  • 3Unger, Nathan, et al. Penicillin Skin Testing: Potential Implications for Antimicrobial Stewardship. Pharmacotherapy 2013; 33 (8): (856-867) doi: 10.1002/phar.1288.
  • 4Roberts RR, Hota B, Ahmad I, et al. Hospital and societal costs of antimicrobial resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis 2009; 49:1175–84.
  • 5King EA, Challa S, Curtin P, Bielory L. Penicillin Skin Testing Hospitalized Patients with Beta-Lactam Allergies: Effect on Antibiotic Selection and Cost. Ann Allergy Asthma Immunol 2016; 117: 67-71.
  • 5Rimawi, Ramzy. et al. The Impact of Penicillin Skin Testing on Clinical Practice and Antimicrobial Stewardship. Journal of Hospital Medicine. Vol. 8. No. 6. June 2013.
  • 6Park, Miguel. et al. Diagnosis and Management of Penicillin Allergy. Mayo Clin Proc. March 2005; 80(3): 405-410.