Pharmacy driven assessment of appropriate antibiotic selection in patients with reported beta‐lactam allergy

Abstract

Background Reported beta‐lactam (BL) antibiotic allergies lead to the avoidance of BL antibiotics. Despite that less than 10% of patients reporting have a true allergy, the documentation often leads to an increased use of alternative antibiotics. These nonpreferred antibiotics (NPA) have a significant impact on cost, clinical outcomes, and antimicrobial resistance. Objective The primary objective of this study was to assess the impact of a pharmacy‐driven assessment on the prescribing frequency of penicillin or cephalosporin antibiotics in patients with a reported BL allergy. Methods This retrospective cohort analysis evaluated the effect of a best practice alert (BPA) and subsequent allergy assessment on BL use in patients with reported allergies at an integrated health system. The BPA notified pharmacy staff that a patient with a documented BL allergy was receiving a NPA. Pharmacy staff assessed previous BL tolerance and clarified reaction, severity, and timing of the documented allergy. Patients were identified for analysis if they had a documented BL allergy within the electronic medical record and received at least one antibiotic during the study period. Results A total of 418 patients were included in this analysis (180 preimplementation, 238 postimplementation). In the pharmacy‐driven assessment group, BL antibiotic use increased by 12.9% (P = .008) in patients with a previously documented BL allergy with the largest use increase in 3rd/4th generation cephalosporins (P = .045). Days of therapy for NPAs decreased in the postimplementation group, including aztreonam (P = .006) and vancomycin (P = .009). Conclusions Our data suggests that a pharmacy‐driven allergy assessment using a BPA can increase appropriate use of BL antibiotics for hospitalized patients.

Overview of Beta-Lactam Allergy and the Role of the Pharmacist in Management

“…Upon notification, the pharmacy staff performed an allergy assessment, which included a review of previous beta-lactam tolerance, and clarification of the reaction type, severity, and timing of the allergy. The pharmacist allergy assessment resulted in increased frequency of beta-lactam prescribing in patients with previously reported beta-lactam allergy, by 12.9%, and a decrease in the days of therapy of non-penicillin antibiotic use, by 123 days of therapy per 1000 patient days, again showing the benefit of pharmacist involvement in penicillin allergy assessment [29].…”