Association Between Removal of a Warning Against Cephalosporin Use in Patients With Penicillin Allergy and Antibiotic Prescribing

Abstract

This cohort study assesses whether removal of a warning against use of cephalosporins in the electronic health record (EHR) of patients with penicillin allergy was associated with changes in the dispensing or administration of cephalosporins.

Antibiotic Use in Patients With β-Lactam Allergies and Pneumonia: Impact of an Antibiotic Side Chain–Based Cross-Reactivity Chart Combined With Enhanced Allergy Assessment

“…For example, a computerized guideline application with clinical decision support incorporating PST and specialist evaluation along with recommendations for later-generation cephalosporin use in patients with mild reactions, and with or without test dosing in patients with type I HSRs, increased prescribing of penicillins and cephalosporins from 38% to 50% in patients with penicillin allergies [ 39 ]. Simply removing the electronic medical record warning to avoid cephalosporin use in patients with penicillin allergies increased cephalosporin use from 18% to 27% without differences in anaphylaxis or new allergies at a large, integrated health system [ 40 ]. We believe incorporation of active interventions through pharmacist and ASP efforts contributed to improvements.…”

Strategies to Reduce Low-Value Cardiovascular Care: A Scientific Statement From the American Heart Association

“…Some tools increase complexity without measurable increases in health care value or may even be harmful. 63 There is growing recognition that EDS may be most effective when coupled with reduction or elimination of reimbursement for low-value care. In 2020, Medicare established the Appropriate Use Criteria Program, which requires consultation with a qualified Clinical Decision Support Mechanism to establish appropriateness for certain advanced imaging tests.…”

“…Some tools increase complexity without measurable increases in health care value or may even be harmful. 63…”

Intravenous antibiotic prophylaxis against infective endocarditis in penicillin‐allergic dental patients

“…In addition, use of second-line antibiotic classes in patients with penicillin allergies may result in other adverse effects, decreased safety, and antimicrobial resistance. 5 A recent US large cohort study (n = 4,206,480) by Macy et al 5 retracted the warning against cephalosporin use in penicillin-allergic patients. In this cohort, there were no significant differences in the rates of anaphylaxis, allergies to new antibiotic classes, antibiotic treatment failure, all-cause mortality, hospital days, and new (secondary) infections with Clostridioides difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus, when cephalosporins were prescribed in patients with penicillin allergy.…”

“…In this cohort, there were no significant differences in the rates of anaphylaxis, allergies to new antibiotic classes, antibiotic treatment failure, all-cause mortality, hospital days, and new (secondary) infections with Clostridioides difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus, when cephalosporins were prescribed in patients with penicillin allergy. 5 Taken all together, some modifications can escape from the gap of the 2021 AHA's guideline on antibiotic prophylaxis against IE. Intravenous ceftriaxone (as a third-generation cephalosporin), clarithromycin, and azithromycin are alternative antibiotic choices for penicillin-allergic dental patients who are unable to take oral medication.…”