Addressing Pediatric Penicillin Allergies through Use of an Inpatient Algorithm - Abstract
Background: The impact of labeling patients penicillin-allergic include increased hospital length-of-stay and use of broad-spectrum antibiotics. Despite these undesirable consequences, few studies have addressed solutions and no protocol existed at our institution to address penicillin allergies in the pediatric population.
Objective: In our quality improvement project, we assessed the impact of implementing an algorithm among penicillin-allergic pediatric inpatients on increasing outpatient referrals for drug allergy evaluation and reducing use of penicillin alternatives.
Methods: Retrospective chart review was conducted to identify penicillin-allergic pediatric inpatients admitted from April 2018 to May 2019 (pre-intervention), and August 2019 to August 2020 (post-intervention, after implementation of the algorithm). The aims of our study were to increase de-labeling, decrease use of penicillin alternatives, and increase allergy referrals.
Results: ?-lactam antibiotics were the preferred drug in 26/36 (72.2%) vs 39/48 (81.3%) in the post-intervention group. Among these patients, there were 10/26 (38.5%) vs 28/39 (71.2%) that received cephalosporins during admission (p = .008). Outpatient referrals for penicillin allergy evaluation were 3/94 (3.2%) in the pre-intervention group and 19/99 (19.2%) in the post intervention group.
Conclusion: Our study suggests that implementation of a penicillin allergy algorithm in a pediatric hospital may be associated with increased outpatient allergy referrals, increased use of cephalosporins, and decreased use of alternative antibiotics.
Clinical Implications: Implementing penicillin allergy algorithms in pediatric hospitals should be considered to address the burden of pediatric penicillin allergy labels.