An educational intervention about the classification of penicillin allergies: effect on the appropriate choice of antibiotic therapy in pregnant women

Thellier, C.; Subtil, D.; Chambure, D. Pelletier De; Grandbastien, Bruno; Catteau, C.; Beaugendre, A.; Poitrenaud, Delphine; Prévotat, A.; Richart, P.; Faure, Karine; Guern, Rémi Le

doi:10.1016/j.ijoa.2019.07.005

Cited by 5 publications

(6 citation statements)

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“…This finding indicates that physicians might be considerably more cautious when prescribing antibiotics for pregnant women and this cautiousness might have a greater effect on antibiotic prescriptions for conditions that only sometimes justify antibiotic use, resulting in potential undertreatment of some infectious conditions. This undertreatment could have harmful effects on maternal and fetal health [ 1 , 2 , 17 ], as infections may increase both maternal and neonatal mortality [ 2 ] and are associated with an increased risk of adverse pregnancy outcomes including spontaneous abortion, prematurity and low birth weight [ 1 , 2 , 3 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotics are among the most commonly prescribed medications in pregnant women for infectious diseases [ 1 , 2 ], which, if untreated, would increase maternal and neonatal mortality and significant fetal risks [ 1 , 2 , 3 ]. In some developed countries, the proportion of pregnant women receiving at least one antibiotic prescription during pregnancy can be as high as 50% [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

et al. 2021

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Background: Antibiotic use in pregnant women at the national level has rarely been reported in China. Objectives: We aimed to investigate antibiotic prescriptions during pregnancy in ambulatory care settings in China. Methods: Data of 4,574,961 ambulatory care visits of pregnant women from October 2014 to April 2018 were analyzed. Percentages of Antibiotic prescriptions by different subgroups and various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Food and Drug Administration (FDA) pregnancy categories were used to describe the antibiotic prescription patterns. The 95% confidence intervals (CIs) were estimated using the Clopper––Pearson method or Goodman method. Results: Among the 4,574,961 outpatient visits during pregnancy, 2.0% (92,514 visits; 95% CI, 2.0–2.0%) were prescribed at least one antibiotic. The percentage of antibiotic prescriptions for pregnant women aged >40 years was 4.9% (95% CI, 4.7–5.0%), whereas that for pregnant women aged 26–30 years was 1.5% (95% CI, 1.4–1.5%). In addition, percentages of antibiotic prescriptions varied among different trimesters of pregnancy, which were 5.4% (95% CI, 5.3–5.4%) for the visits in the first trimester of pregnancy and 0.5% (95% CI, 0.4–0.5%) in the third trimester of pregnancy. Furthermore, the percentages of antibiotic prescriptions substantially varied among different diagnosis categories and nearly three-quarters of antibiotic prescriptions had no clear indications and thus might be inappropriate. In total, 130,308 individual antibiotics were prescribed; among these, 60.4% (95% CI, 60.0–60.8%) belonged to FDA category B, 2.7% (95% CI, 2.1–3.5%) were classified as FDA category D and 16.8% (95% CI, 16.2–17.4%) were not assigned any FDA pregnancy category. Conclusions: Antibiotic prescriptions in ambulatory care during pregnancy were not highly prevalent in mainland China. However, a substantial proportion of antibiotics might have been prescribed without adequate indications. Antibiotics whose fetal safety has not been sufficiently illustrated were widely used in pregnant women.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

et al. 2021

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“…We included 30 primary studies that assessed the frequency of cefazolin allergy in series of patients with self-reported or confirmed penicillin allergy (Table 1). The included primary studies had been published between 1976 and 2020, assessing a total of 6001 participants. In 9 studies, penicillin allergy was confirmed by diagnostic testing (skin, in vitro, and/or drug challenges).…”

Section: Resultsmentioning

confidence: 99%

“…In 13 studies, 18,20,22,23,25,31,32,34,[37][38][39][40]44 cefazolin allergy was assessed by means of skin tests or drug challenges, whereas prophylactic or therapeutic introduction of cefazolin occurred in 18 studies. 17,19,21,24,[26][27][28][29][30]33,[35][36][37][41][42][43]45,46 Cefazolin allergy was identified in 44 participants, resulting in a meta-analytical frequency of 0.7% (95% CrI, 0.1%-1.7%; I 2 = 74.9%) (Figure 2A). Such frequency was lower for participants with self-reported penicillin allergy (0.6%; 95% CrI, 0.1%-1.3%; I 2 = 54.3%) than for those with confirmed allergic reactions (3.0%; 95% CrI, 0.01%-17.0%; I 2 = 88.2%) (OR, 0.4; 95% CrI, 0.02-1.8; 92% probability of OR <1).…”

Section: Frequency Of Cefazolin Allergy In Patients With Penicillin A...mentioning

confidence: 99%

Assessment of the Frequency of Dual Allergy to Penicillins and Cefazolin

et al. 2021

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IMPORTANCE Cefazolin is the preoperative antibiotic of choice because it is safer and more efficacious than second-line alternatives. Surgical patients labeled as having penicillin allergy are less likely to prophylactically receive cefazolin and more likely to receive clindamycin or vancomycin, which results in higher rates of surgical site infections.OBJECTIVE To examine the incidence of dual allergy to cefazolin and natural penicillins.DATA SOURCES MEDLINE/PubMed, Web of Science, and Embase were searched without language restrictions for relevant articles published from database inception until July 31, 2020.STUDY SELECTION In this systematic review and meta-analysis, a search of MEDLINE/PubMed, Web of Science, and Embase was performed for articles published from database inception to July 31, 2020, for studies that included patients who had index allergies to a natural penicillin and were tested for tolerability to cefazolin or that included patients who had index allergies to cefazolin and were tested for tolerability to a natural penicillin. A total of 3228 studies were identified and 2911 were screened for inclusion.DATA EXTRACTION AND SYNTHESIS Data were independently extracted by 2 authors. Bayesian meta-analysis was used to estimate the frequency of allergic reactions. MAIN OUTCOMES AND MEASURESDual allergy to cefazolin and a natural penicillin. RESULTSSeventy-seven unique studies met the eligibility criteria, yielding 6147 patients. Cefazolin allergy was identified in 44 participants with a history of penicillin allergy, resulting in a dual allergy meta-analytical frequency of 0.7% (95% credible interval [CrI], 0.1%-1.7%; I 2 = 74.9%). Such frequency was lower for participants with unconfirmed (0.6%; 95% CrI, 0.1%-1.3%; I 2 = 54.3%) than for those with confirmed penicillin allergy (3.0%; 95% CrI, 0.01%-17.0%; I 2 = 88.2%). Thirteen studies exclusively assessed surgical patients (n = 3884), among whom 0.7% (95% CrI, 0%-3.3%; I 2 = 85.5%) had confirmed allergy to cefazolin. Low heterogeneity was observed for studies of patients with unconfirmed penicillin allergy who had been exposed to perioperative cefazolin (0.1%; 95% CrI, 0.1%-0.3%; I 2 = 13.1%). Penicillin allergy was confirmed in 16 participants with a history of cefazolin allergy, resulting in a meta-analytical frequency of 3.7% (95% CrI, 0.03%-13.3%; I 2 = 64.4%). The frequency of penicillin allergy was 4.4% (95% CrI, 0%-23.0%; I 2 = 75%) for the 8 studies that exclusively assessed surgical patients allergic to cefazolin.CONCLUSIONS AND RELEVANCE These findings suggest that most patients with a penicillin allergy history may safely receive cefazolin. The exception is patients with confirmed penicillin allergy in whom additional care is warranted.

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“…A thorough allergy history can differentiate allergies from adverse reactions and, if present, determine the type of MOTS-CLÉS : allergie, anaphylaxie, bêtalactamine, dossier de santé électronique, gestion antibiotique, réactivité croisée, pénicilline antibiotic prescribing guideline for patients with penicillin or cephalosporin allergies (24). Another study demonstrated that providing a short educational presentation of the guideline increased the rate of appropriate antibiotic treatment selection, predefined on the basis of level of allergy risk, by 50% (25). Another approach has been to update prescribing alerting rules to reflect this change in practice.…”

Section: Introductionmentioning

confidence: 99%

β-lactam exposure outcome among patients with a documented allergy to penicillins post-implementation of a new electronic medical record system and alerting rules

Buffone

Lin

Grant

2021

Official Journal of the Association of Medical Microbiology and

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Background: Recent studies suggest that type I hypersensitivity cross-reactivity between β-lactam antibiotics is due to side chain similarity and not the common β-lactam ring. As a result, the prescriber-alerting rules of an electronic medical record (EMR) system were adjusted to only flag prescribers when prescribing penicillins or β-lactams with similar side chains (viz, cephalexin, cefadroxil, and cefoxitin) to patients with a documented allergy to penicillins. This study was conducted to assess and confirm the safety of the adjusted alerting rules; the primary outcome was the prevalence of anaphylaxis on β-lactam re-exposure. Methods: Retrospective chart review was conducted for patients who, under the reformed alerting rules, received a β-lactam antibiotic post-documentation of an allergy to penicillins in their EMR from April 2018 to July 2019 at a 268-bed community hospital. Given the volume of eligible patients, a 25% sample was randomly selected for review from initiation of the β-lactam antibiotic up to 30 days post-exposure to determine the prevalence of anaphylaxis. Results: Of the 325 charts reviewed, 300 (92.3%) received a β-lactam antibiotic with a different side chain than penicillins (not alerted on prescribing). Chart review of these 300 patients confirmed no reports of anaphylaxis secondary to β-lactam exposure (0%), and two patients developed non-anaphylactic delayed reactions (rash). Conclusions: There were no reports of immediate life-threatening anaphylaxis under the reformed alerting rules, despite 25 (7.7%) patients receiving an alerted drug, such as piperacillin–tazobactam. The reformed alerting rules better reflect current literature and reduce the risk of prescriber-alerting fatigue without compromising patient safety. The occurrence of delayed reactions reinforced the need to monitor for these reactions on β-lactam antibiotic prescribing.

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An educational intervention about the classification of penicillin allergies: effect on the appropriate choice of antibiotic therapy in pregnant women

Cited by 5 publications

References 32 publications

Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

Assessment of the Frequency of Dual Allergy to Penicillins and Cefazolin

β-lactam exposure outcome among patients with a documented allergy to penicillins post-implementation of a new electronic medical record system and alerting rules

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