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Over-reporting of penicillin allergy is a major public health concern, associated with inappropriate antibiotics prescribing, high hospital costs and increased resistance to antibiotics.

Globally, healthcare professionals and researchers are increasingly interested in the positive impact of removing penicillin allergies from patients’ records (delabeling) and the use of penicillin point-of-care programs, like direct oral penicillin challenge (i.e. test dose).

New research from the Peter Doherty Institute for Infection and Immunity (Doherty Institute) and Austin Health confirms the importance of penicillin allergy delabeling and identifies an efficient way of assessing which patients are suitable for and more likely to benefit from inpatient direct oral challenge.

Published in Clinical Infectious Diseases, the study found that the patient’s acute need for β-lactam antibiotics, low-risk allergy types, medical stability/complexity are all key clinical factors that help assess suitability for the patient to access the inpatient penicillin delabeling.

Senior author of the study and Lead of the Centre for Antibiotic Allergy and Research, University of Melbourne’s Associate Professor Jason Trubiano, said he hopes his findings will inform hospital management of penicillin allergy in the future. 

"In resource-limited settings, or where allergy services are limited, efficiently and quickly identifying patients suitable for a direct oral challenge is likely to be advantageous for the patients and health services,” Associate Professor Trubiano said.

The research also shows that those who are most likely to require antibiotic therapy would benefit from penicillin allergy delabeling, and that direct oral penicillin challenge led to an improved antibiotic appropriateness in inpatients with low-risk penicillin.

With 50 per cent of inpatients with low-risk penicillin allergy, it is clear the use of direct oral penicillin challenge not only benefits patients, but also the hospital and the battle against antimicrobial resistance (AMR).

“We know that if a penicillin allergy is listed in your medical records, you are more likely to experience negative outcomes, like having an antibiotic-resistant superbug,” Associate Professor Trubiano said.

“By delabeling, we are reducing the patient’s chances of developing superbugs and making sure the right antibiotics is used. It’s a central pillar in the fight against superbugs.”

“Our research will be able to teach hospitals how to set up penicillin allergy delabeling programs, and it will inform health services all around Australia.”

Peer review: Clinical Infectious Diseases https://doi.org/10.1093/cid/ciad156