Effect of a Drug Allergy Educational Program and Antibiotic Prescribing Guideline on Inpatient Clinical Providers’ Antibiotic Prescribing Knowledge

Abstract

Background Inpatient providers have varying levels of knowledge in managing patients with drug and/or penicillin (PCN) allergy. Objectives Our objectives were: 1) to survey inpatient providers to ascertain their baseline drug allergy knowledge and preparedness in caring for patients with PCN allergy and 2) to assess the impact of an educational program paired with the implementation of a hospital-based clinical guideline. Methods We electronically surveyed 521 inpatient providers at a tertiary care medical center at baseline and again six weeks after an educational initiative paired with clinical guideline implementation. The guideline informed providers on drug allergy history taking and antibiotic prescribing for inpatients with PCN or cephalosporin allergy. Results Of 323 unique responders, 42% [95% CI 3748%] reported no prior education in drug allergy. Considering those who responded to both surveys (N=213), we observed a significant increase in knowledge about PCN skin testing (35% vs. 54%, p<0.001) and loss of PCN allergy over time (54% vs. 80%, p<0.0001). Among those who reported attending an educational session (N=62), preparedness to determine if an allergy was severe significantly improved (77% vs. 92%, p=0.03). Other areas, including understanding absolute contraindications to receiving a drug again and PCN cross-reactivity with other antimicrobials, did not improve significantly. Conclusion Inpatient providers have drug allergy knowledge deficits but are interested in tools to help them care for inpatients with drug allergies. Our educational initiative and hospital guideline implementation were associated with increased PCN allergy knowledge in several crucial areas. To improve care of drug-allergic inpatients, more research is needed to evaluate hospital policies and sustainable educational tools.

Improving Antimicrobial Stewardship by Antibiotic Allergy Delabeling: Evaluation of Knowledge, Attitude, and Practices Throughout the Emerging Infections Network

“…Although not addressed in this survey, applying this evidence into clinical practice may help effect change in these common clinicial scenarios [18]. More encouragingly, Blumenthal et al [6] demonstrated that clinician practices could be altered with decision support and a guided education program.…”

Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2014

“…Studies also documented a lack of understanding of drug allergy among physicians 78 and poor treatment and low referral for drug allergy testing from the emergency department, 79 whereas another study showed how educational interventions could improve a physician's understanding of drug allergy. 80 Several studies addressed drug allergy testing. 81 Fox and Park 82 suggested the safety and efficacy of penicillin skin testing.…”

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“…Several mechanisms of action have been proposed for the anti-inflammatory efficacy of antibiotics and traditional Chinese medicines (TCMs) on respiratory diseases, including COPD, house dust mite-induced allergic asthma, resistance of Klebsiella pneumoniae, and ventilator-associated pneumonia (12)(13)(14)(15). However, the efficacy of such antibiotics was limited by their side effects in clinical trials, which included vomiting, diarrhea, weight loss and headaches (16)(17)(18). At present, no effective control measures have been developed for the treatment of PM 2.5 -induced respiratory diseases apart from reducing PM 2.5 emissions, wearing a dust respirator and increasing the number of plants.…”