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