Pharmacy-Led β-Lactam Allergy Interview (BLAI) Reduces Duration of Fluoroquinolones Within a Community Hospital

Abstract

Background: Patients with reported β-lactam allergies often receive broad-spectrum antimicrobials and have been shown to experience a variety of negative health consequences, such as increased mortality, costs, readmission, and adverse reactions. Current literature focuses on β-lactam allergy skin testing but lacks evidence on β-lactam allergy interviews (BLAI) when skin testing is unavailable. Objective: This study aimed to test the impact of a pharmacy-led BLAI on duration of fluoroquinolones at a community hospital. Methods: A quasi-experimental design with a prospective cohort design and historical control group was used to assess patients with reported penicillin (PCN) allergies in a community hospital. The primary outcome was duration of fluoroquinolones before and after implementation of BLAI. Secondary outcomes included length of stay (LOS), percentage of patients switched to a β-lactam antibiotic, percentage of antimicrobial stewardship recommendations made/accepted, and discrepancies between allergy in medical record and interview-reported allergy. Nonparametric continuous data and medians were evaluated by Mann-Whitney U. Results: A total of 80 patients were included in the study (43 in the control group and 37 in the prospective group). Fluoroquinolone duration was reduced after the implementation of BLAI (3.7 vs 2.7 days, P = 0.027). In all, 49% of patients in the prospective group were switched to a β-lactam antibiotic after BLAI, with no allergic reactions, adverse effects, or impact on LOS. Conclusion and Relevance: BLAI resulted in a significant reduction in fluoroquinolone duration in patients with PCN allergies and may represent a safe and effective option for institutions lacking skin-testing capabilities.

Providers' knowledge and perceptions regarding antibiotic stewardship and antibiotic prescribing in rural primary care clinics

“…Encouragingly, most providers indicated they performed appropriate penicillin allergy assessments and were aware of the statistics for those truly allergic with labeled penicillin allergies . While the nature of these assessments and implications for antibiotic prescribing were not evaluated in our study, these practices previously demonstrated reduced fluoroquinolone prescriptions when penicillin allergies were appropriately de‐labeled . It is reassuring that providers recognized that antibiotics are unnecessary for nearly all cases of asymptomatic bacteriuria because this is another condition that contributes to significant antibiotic overprescribing .…”

Penicillin allergies

“…Patients with reported penicillin allergies have been shown to have increased rates of MRSA 22. Increased fluoroquinolone use in the setting of listed penicillin allergy may also be driving rises in drug-resistant strains of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa 24. The CDC recognizes reported drug allergies as a potential cause for increased antibiotic-resistance rates and includes accurate allergy assessments as a recommended antimicrobial stewardship intervention 25…”

Strategies for Clarifying Penicillin Allergies When Skin Testing Is Not an Option

“…Similarly, a study by Devchand et al showed improved performance of an allergy assessment tool when carried out by pharmacists and senior doctors [27]. A recent study by Covington et al described the use of fourth-year pharmacy students as pharmacist extenders to clarify beta-lactam allergies, with supervision from clinical pharmacists and/or pharmacy residents [28]. This could represent a strategy for institutions with advanced pharmacy practice experience (APPE) students.…”

“…Within the prospective group, 18 patients (49%) were switched to a beta-lactam after the interview and no adverse reactions were noted. Interestingly, 41% of those interviewed reported receiving a beta-lactam antibiotic in the past with no reaction which again emphasizes the importance of conducting a thorough allergy interview [28].…”