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Pharmacy driven assessment of appropriate antibiotic selection in patients with reported beta‐lactam allergy
Author(s) -
Holmes Ashley K.,
Bennett Nicholas T.,
Berry Timothy P.
Publication year - 2019
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1135
Subject(s) - medicine , allergy , antibiotics , pharmacy , cephalosporin , penicillin , intensive care medicine , pediatrics , family medicine , immunology , microbiology and biotechnology , biology
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.