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Background While 10% of the population may report a penicillin (PCN) allergy, it has been shown that 90% of these patients are not allergic and may still be able to take PCN safely. Inaccurate reporting of a PCN allergy may lead to prescription of other non-B-lactam or broader spectrum antibiotics. Inpatients with reported antibiotic allergy status have been shown to have inappropriate antibiotic prescribing, increase microbiologic resistance, and suboptimal patient outcomes. Our goal was to evaluate antibiotic prescribing patterns for children with CAP in the setting of reported antibiotic allergy. Methods The Children’s Hospital’s Initiative for Research in Pneumonia (CHIRP) study enrolled inpatient and outpatient children ≥2 months to 18 years of age with a diagnosis of CAP from six participating sites. Demographic data, allergy status, antimicrobial therapy, and clinical outcomes were collected. Overall prevalence of reported antibiotic allergy and alternative therapy used in setting of reported allergy were analyzed. Results A total of 470 subjects were included, enrolled from October 2015 to December 2017. The mean age was 6.3 years (range: 3 months to 18.9 years), 45% were females. Sixty-three (13.4%) subjects self-reported one or more antibiotic allergies. Twenty-seven subjects reported amoxicillin (AMOX) allergy, nine with PCN allergy, nine with amox/clavulanate (AMOX/CLAV) allergy, and 11 with ampicillin (AMP) or ampicillin/sulbactam allergy. Cephalosporin allergy was reported in seven subjects. Of the 47 subjects who reported AMOX or AMP allergy, 37 (79%) were treated with ceftriaxone, a broad-spectrum agent. In the 47 subjects with reported AMOX or AMP allergy, five (10.6%) were prescribed AMOX at discharge. Of the three subjects with reported levofloxacin allergy, two were treated with levofloxacin during hospitalization for CAP as well as at the time of discharge. Conclusion Most subjects with reported AMOX allergy were treated with alternative and broader-spectrum antibiotics. In our cohort, 10.6% still received the antibiotic despite the allergy labeling. Better confirmation of allergy history to hone appropriate antimicrobial therapy appears to be indicated. Disclosures D. Cohen, Nationwide Children’s Hospital: Research Contractor, Research support. A. Mejias, Janssen: Grant Investigator and Scientific Advisor, Consulting fee and Research grant. Abbvie: CME talks, Speaker honorarium. O. Ramilo, Janssen Scientific Affairs, LLC: Consultant, Consulting fee. Sanofi: Scientific Advisor, Consulting fee. Merck: Scientific Advisor, Consulting fee and Speaker honorarium. Janssen: Grant Investigator and Scientific Advisor, Consulting fee, Grant recipient and Speaker honorarium. Pfizer: Consultant, Consulting fee and Speaker honorarium.

261. Alternative Antibiotic Prescribing for Community Acquired Pneumonia (CAP) in Pediatric Patients in Relation to Allergy Status