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Cephalosporin use in penicillin‐allergic patients: A survey of otolaryngologists and literature review
Author(s) -
Persky Michael J.,
Roof Scott A.,
Fang Yixin,
Jethanamest Daniel,
April Max M.
Publication year - 2015
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25227
Subject(s) - medicine , guideline , cefdinir , otorhinolaryngology , penicillin , allergy , amoxicillin , pediatrics , cephalosporin , cephalosporin antibiotic , family medicine , intensive care medicine , antibiotics , surgery , immunology , pathology , microbiology and biotechnology , biology
Objectives/Hypothesis This study investigated the differences between the standard guidelines and the practice patterns of otolaryngologists in managing “penicillin‐allergic” patients. A major goal was to identify factors influencing an otolaryngologist's choice of antibiotic. Study Design Cross‐sectional survey. Methods Four hundred seventy members of the American Society of Pediatric Otolaryngologists (ASPO) and 150 general otolaryngologists from the Florida Society of Otolaryngology (FSO) were surveyed. Results Ninety‐six ASPO members (20.4%) and 22 members of FSO (14.6%) responded. When asked about the management of a pediatric patient with acute otitis media and a history of a nonsevere immunoglobulin E (IgE)‐mediated amoxicillin allergy, 54% of ASPO respondents indicated they would initiate guideline‐recommended cefdinir, whereas only 27% of FSO respondents chose cefdinir ( P = .02). Otolaryngologists who are fellowship trained in pediatrics or have pediatric‐focused practices were significantly more likely to prescribe cefdinir. Overall, 57% of respondents indicated that they were familiar with the literature regarding the cross‐reactivity of β‐lactams, but only 25% of respondents felt that they could easily differentiate a potentially life‐threatening IgE‐mediated allergy from a non–IgE‐mediated drug intolerance. Conclusions The data show differences between the current recommendations and the behavior of otolaryngologists. Pediatric otolaryngologists were more familiar with the guideline‐recommended therapy, likely from their frequent exposure to patients requiring a β‐lactam. Nevertheless, most otolaryngologists could benefit from increased awareness of the current literature. Patients may be receiving less than optimal medication management due to a misidentification of those at risk of life‐ threatening allergic cross‐reactions. Level of Evidence NA Laryngoscope , 125:1822–1826, 2015