Promoting Antibiotic Stewardship with Beta-lactam Allergy ‘De-labeling’

Approximately 10 % of patients report allergies to penicillin (1-3). When these patients require antibiotics, they often receive less effective, more toxic, more broad-spectrum, and more expensive agents than patients without reported penicillin allergies (3). For example, alternative agents to beta-lactam antibiotics include vancomycin and aminoglycosides, which require therapeutic drug monitoring and carry risks of nephrotoxicity and ototoxicity. Clinicians may also prescribe alternative agents such as aztreonam, which is expensive and has less proven clinical efficacy for most types of infections, or fluoroquinolones, which are broad-spectrum and notorious for inciting C. difficile infection. Penicillin allergy labels have been associated with increased length of hospital stay, hospitalization costs, antibiotic resistance (e.g., MRSA, C. difficile, and VRE infections), and even mortality (2,4). Thus, allergy labeling is a focus area for antimicrobial stewardship programs (ASPs) to prevent resistant infections and improve patient safety. This newsletter discusses strategies that ASPs can use to maximize both appropriateness of antibiotic therapy and safety for hospitalized patients with reported beta-lactam allergies. Many ASPs start with a focus on detailed allergy history, education, and improved allergy documentation as a means to “de-label ” patients who are not truly beta-lactam allergic AND improve the recognition of patients at risk fo