Penicillin allergy delabeling has a significant impact on subsequent antibiotic use in primary care

• Published in: The World Allergy Organization journal Vol. 17; no. 9; p. 100958
• Main Authors: Fransson, Sara, Boel, Jonas B., Mosbech, Holger F., Garvey, Lene H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2024; World Allergy Organization; Elsevier
• Subjects: Antibiotic prescriptions; Brief Research Report; Delabeling; Drug provocation; Penicillin allergy; Primary care; Delabeling; Primary care; Penicillin allergy; Antibiotic prescriptions; Drug provocation
• ISSN: 1939-4551; 1939-4551
• DOI: 10.1016/j.waojou.2024.100958

Efforts to delabel penicillin allergic patients are important as the majority of suspected penicillin allergy can be ruled out by relevant allergy testing. The aim is to change the antibiotic pattern in delabeled patients to minimize use of unnecessary broad-spectrum antibiotics, reducing the risk of antimicrobial resistance and making treatment more cost effective. However, published information on subsequent antibiotic use is scarce.
To evaluate the effect of delabeling on subsequent antibiotic use in primary care, a cohort of 2911 patients tested for penicillin allergy was compared to a matched control group of 14,522 individuals from the background population. In total 86.4% of the tested patients were delabeled.
For delabeled patients, penicillin use increased from 0.07 prescriptions per patient year before allergy investigation, to 0.53 prescriptions per patient year post investigation (p < 0.001). The use of fluoroquinolones and macrolides was reduced and reached a level comparable to the background population.
This study shows that penicillin allergy delabeling has significant positive impact on subsequent antibiotic use in primary care, and that penicillin use increases to levels similar to the background population. Penicillin allergy delabeling should be prioritized as an important and efficient element in antimicrobial stewardship initiatives.