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Title: Evaluation of a pharmacist-led penicillin allergy de-labelling ward round: a novel antimicrobial stewardship intervention.
Austin Authors: Devchand, Misha ;Kirkpatrick, C M J;Stevenson, W;Garrett, Kent ;Perera, Dhineli ;Khumra, Sharmila ;Urbancic, Karen F ;Grayson, M Lindsay ;Trubiano, Jason 
Affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Victoria, Australia
Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 1-Jun-2019
Date: 2019-03-14
Publication information: The Journal of antimicrobial chemotherapy 2019; 74(6): 1725-1730
Abstract: Antibiotic allergy labels (AALs), reported by up to 25% of hospitalized patients, are a significant barrier to appropriate prescribing and a focus of antimicrobial stewardship (AMS) programmes. A prospective audit of a pharmacist-led AMS penicillin allergy de-labelling ward round at Austin Health (Melbourne, Australia) was evaluated. Eligible inpatients with a documented penicillin allergy receiving an antibiotic were identified via an electronic medical report and then reviewed by a pharmacist-led AMS team. The audit outcomes evaluated were: (i) AMS post-prescription review recommendations; (ii) direct de-labelling; (iii) inpatient oral rechallenge referral; (iv) skin prick testing/intradermal testing referral; and (v) outpatient antibiotic allergy clinic assessment. Across a 5 month period, 106 patients were identified from a real-time electronic prescribing antibiotic allergy report. The highest rate of penicillin allergy de-labelling was demonstrated in patients who were referred for an inpatient oral rechallenge with 95.2% (n = 21) successfully having their penicillin AAL removed. From the 22 patients with Type A reactions, 63.6% had their penicillin AAL removed. We demonstrated a significant decrease in the prescribing of restricted antibiotics (defined as third- or fourth-generation cephalosporins, fluoroquinolones, glycopeptides, carbapenems, piperacillin/tazobactam, lincosamides, linezolid or daptomycin) in patients reviewed (pre 42.5% versus post 17.9%, P = 0.0002). A pharmacist-led AMS penicillin allergy de-labelling ward round reduced penicillin AALs and the prescribing of restricted antibiotics. This model could be implemented at other hospitals with existing AMS programmes.
DOI: 10.1093/jac/dkz082
ORCID: 0000-0002-9275-578X
Journal: The Journal of antimicrobial chemotherapy
PubMed URL: 30869124
Type: Journal Article
Appears in Collections:Journal articles

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