September 28, 2018 marks 90 years since Sir Alexander Fleming discovered penicillin as an effective antimicrobial which would soon save millions of lives. He warned soon afterwards that unless we used penicillin judiciously, we would see antibiotic resistance, and he was right. With decades of inappropriate antibiotic prescribing, we have dug ourselves a deep hole of antimicrobial resistance, and inaccurate penicillin allergies is but one shovel used to put us in this mess.
How? Simple if/and/then construct: IF unverified penicillin allergies lead to unnecessary/inappropriate use of broad-spectrum antibiotics which contributes to antimicrobial resistance, AND antimicrobial resistance is a public health problem, THEN unverified penicillin allergies are a public health problem.
In a single day on hospital service the infectious diseases consult team encountered a few patients with beta-lactam allergies: one had developed significant angioedema in the last year with amoxicillin; another had developed a questionable rash on nafcillin therapy; a third recalled his mother telling him that he turned green after receiving oral penicillin as a child. Our approach: in the first case we avoided penicillin; in the second, we recommended a cephalosporin graded challenge which the patient tolerated; in the third, after detailed history we gave the patient full dose amoxicillin-clavulanate, he tolerated it well and he was able to discharge without IV antibiotics. These are fantastic cases for teaching purposes, but additionally, how exhilarating it is to liberate a patient from an irrelevant penicillin “allergy” and give them appropriate treatment upfront!
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
