Strategies to identify and prevent penicillin allergy mislabeling and appropriately de-label patients

Consequences of mislabeling

Clinical consequences. A multitude of clinical consequences result from carrying a “penicillin allergy” label.

Use of broad-spectrum antibiotics leads to increased risk of Clostridium difficile infection and to development of resistant bacteria, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus.^2,15

Alternative antibiotics used in the setting of a “penicillin allergy” label might be less efficacious and result in suboptimal outcomes.

Alternative antibiotics used in the setting of a “penicillin allergy” label might be less efficacious and result in suboptimal outcomes. For example, vancomycin is less effective against methicillin-sensitive S aureus bacteremia than nafcillin or cefazolin.^2,21 Beta-­lactam antibiotics—in particular, cefazolin—are often first-line for perioperative prophylaxis; patients with reported penicillin allergy often receive a less-optimal alternative, such as clindamycin, vancomycin, or gentamicin.²² These patients are at increased risk of surgical site infection.^2,22

In addition, using penicillin alternatives can result in greater risk of drug reactions and adverse effects.²

Increased health care costs. Primarily through observational studies, penicillin allergy has been associated with higher health care costs.²³ Patients with reported penicillin allergy had, on average, a longer inpatient stay than patients without penicillin allergy, at a 3-year total estimated additional cost of $64.6 million.²⁴ Inpatients with a listed penicillin allergy had direct drug costs ranging from “no difference” to $609 per patient more than patients without a listed penicillin allergy. Outpatient prescription costs were $14 to $193 higher per patient for patients with a listed penicillin allergy.²³

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