BETA-LACTAM ALLERGY: BENEFITS OF DE-LABELING CAN BE ACHIEVED SAFELY
Far too many patients carry an inaccurate label of beta-lactam allergy. These individual consequently receive alternative antibiotics, often with too broad a spectrum, a higher risk of adverse events, an increased chance of selecting for resistance, and greater cost.
Careful stewardship of antimicrobials not only means reducing unnecessary use of antibiotics, but also ensuring the safest and most appropriate drug is chosen when antibiotic treatment is indicated. Beta-lactam allergy de-labelling (removing the allergy alert from an individual’s health record) is an important step in this process.
The Antibiotic Wise initiative at the BC Centre for Disease Control recently published an article in the BC Medical Journal reviewing the issue of incorrect beta-lactam allergy, as well as best practice for assessing and treating patients who indicate they have an allergy.
While 1 in 10 patients are labelled with a penicillin allergy and 1 in 50 with a cephalosporin allergy, only a small fraction of those individuals react positively to a penicillin skin test. The discrepancy in these numbers indicates a significant opportunity for improved assessment strategies by healthcare practitioners and education of the public.
Tools are available to help assess beta-lactam allergies and determine the most appropriate treatment.
Figure 1 is an Beta-Lactam Cross-Allergy Chart showing that many cephalosporins are safe to prescribe to those with penicillin allergies (due to cross-reactivity being mainly due to side chain similarity rather than beta-lactam ring structure in cephalosporins)
Figure 2 is an example of a flowchart which can aid assessment via a short, logical series of questions to determine the most optimal antibiotic.
Pharmacists and pharmacy technicians have an important role to play in reviewing patients’ antibiotic prescriptions and identifying potential inaccurate labeling of a beta-lactam allergy. Pharmacists can also help by assessing allergy symptoms, and providing education to both patients and prescribers. For more information, read the entire article in the BC Medical Journal, and visit www.antibioticwise.ca to learn more.
Antibiotic Wise is an initiative of the BC Centre for Disease Control providing information for the public and professionals about antibiotic resistance and the proper use of antibiotics.
Project Manager, Community Antimicrobial Stewardship
BC Centre for Disease Control
Nick is the Project Manager for the Community Antimicrobial Stewardship program at the BC Centre for Disease Control, which includes the Antibiotic Wise initiative and Do Bugs Need Drugs? education program.