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Old but not forgotten: Antibiotic allergies in General Medicine (the AGM Study)
Author(s) -
Trubiano Jason A,
Pai Mangalore Rekha,
Baey YiWei,
Le Duy,
Graudins Linda V,
Charles Patrick GP,
Johnson Douglas F,
Aung Ar Kar
Publication year - 2016
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja15.01329
Subject(s) - medicine , interquartile range , medical record , cohort , allergy , demographics , medical history , antibiotics , pediatrics , electronic medical record , emergency medicine , demography , immunology , sociology , microbiology and biotechnology , biology
Objectives: To determine the nature, prevalence and description accuracy of recorded antibiotic allergy labels (AALs) in a cohort of general medical inpatients, and to assess the feasibility of an oral antibiotic re‐challenge study. Design: Multicentre cross‐sectional study. Setting and participants: All patients admitted to the general medical units of Austin Health and Alfred Health, 18 May – 5 June 2015. Main outcome measures: Baseline demographics, medical and allergy history, infection diagnoses and antibiotic prescribing data for general medical inpatients were collected. A questionnaire was administered to clarify AAL history, followed by correlation of responses with electronic and admissions record descriptions. A hypothetical oral re‐challenge in a supervised setting was offered to patients with low risk allergy phenotypes (non‐immediate reaction, non‐severe cutaneous adverse reaction, or unknown reaction more than 10 years ago). Results: Of the 453 inpatients, 107 (24%) had an AAL (median age, 82 years; interquartile range, 74–87 years); 160 individual AALs were recorded, and there was a mismatch in AAL description between recording platforms in 25% of cases. Most patients with an AAL were women (64%; P < 0.001), and more presented with concurrent immunosuppression than those without an AAL (23% v 8%; P < 0.001). β‐Lactam penicillins were employed less frequently in patients with an AAL (16% v 35%; P = 0.02), while ceftriaxone (32% v 20%; P = 0.02) and fluoroquinolones (6% v 2%; P = 0.04) were used more often. Fifty‐four per cent of patients with AALs were willing to undergo oral re‐challenge, of whom 48% had a low risk allergy phenotype. Conclusions: AAL prevalence in general medical inpatients was 24%, and was associated with excessive use of broad spectrum antibiotics. Allergies in a large proportion of patients with AALs were incorrectly documented, and were non‐immune‐mediated and potentially amenable to oral re‐challenge. A direct oral re‐challenge study in carefully selected patients with low risk allergy phenotypes appears feasible.