This article is more than 5 years old. Information may no longer be current.
Physician knowledge of allergies key in improving antimicrobial use
Infectious disease physicians are frequently consulted to evaluate patients with reported antimicrobial allergies, making their knowledge of allergies central to improving antimicrobial use, according to a research letter published in JAMA Internal Medicine.
"Based on our findings, we hope that clinicians will consider prescribing antibiotics judiciously for their patients, and carefully evaluate if the patient has a true allergic reaction before prescribing alternative agents," study researcher Lilian M. Abbo, MD, of the division of infectious diseases at the University of Miami Miller School of Medicine, told Infectious Disease News.
Lilian M. Abbo
Abbo and colleagues surveyed 1,411 members of the Infectious Diseases Society of America’s Emerging Infections Network. The 10-item questionnaire assessed physicians’ perceptions and knowledge of antimicrobial allergy. Of those surveyed, 72% were adult ID physicians, 23% were pediatric ID physicians and 5% were both.
Results showed that 78% of physicians surveyed had been consulted at least once in the past month to evaluate a patient with a possible antimicrobial allergy. The patient or family member (97%) and medical records (89%) were the most common sources of information regarding allergy history.
Sixty percent of the respondents had access to a penicillin skin test, most of whom were allergy and/or immunology physicians (90%). Of those who had a penicillin skin test available, 88% said preoperative skin tests were on hand for elective surgical procedures. However, skin tests were not routinely used in 75% of those procedures.
Abbo and colleagues also presented the physicians with a series of clinical scenarios to assess their care of patients with possible antimicrobial allergy. One case included “an adult with remote history of mild skin reaction to a sulfa medication, diagnosed as AIDS and severe Pneumocystis jiroveci pneumonia.” One-third of respondents elected to treat with an alternative agent, although trimethoprim-sulfamethoxazole is the recommended first-line therapy for P. jiroveci.
In another clinical scenario in which a patient with an uncertain history of allergy to penicillin was being treated for methicillin-susceptible Staphylococcus aureus, a “nontrivial” number of respondents opted to treat with vancomycin, according to the researchers.
“When treating severe staphylococcal infections, physicians must balance the relative ease of continued administration of potentially less-effective antimicrobials with the more effective but challenging administration of [beta]-lactams,” they wrote. “Despite existing recommendations suggesting prudent vancomycin use, this agent continues to be inappropriately used, particularly for patients reporting questionable penicillin allergy.”
The researchers said accurate use of “allergy labels” might help physicians to safely treat more patients with first-line agents such as penicillin.
“Antimicrobial-specific guidelines from IDSA should be considered to assist ID physicians in allergy management,” they wrote.
Accurately identifying antimicrobial allergies can significantly reduce immediate risks for drug-related adverse events in adults and children, according to Abbo.
"Patients with poor recollection or a questionable past medical history about an antibiotic-related allergy can also discuss the possibility of being referred to an allergy specialist, to confirm if they are truly allergic to the antibiotic," she said.
For more information:
Lilian M. Abbo, MD, can be reached at LAbbo@med.miami.edu.
Disclosure: Abbo reports no relevant financial disclosures.