Ruling out penicillin allergy by testing inpatients saves money

(HealthDay)—Inpatient penicillin allergy testing is effective for ruling out penicillin allergy, and results in increased prescription of penicillin and cephalosporin, according to a review published online March 29 in Allergy.

Keith A. Sacco, M.D., from the Mayo Clinic in Jacksonville, Fla., and colleagues conducted a systematic review of the literature to examine whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization. Data were included for 24 studies that met eligibility criteria.

The researchers found that the main intervention described was penicillin skin testing (PST) with or without oral amoxicillin challenge (18 studies). For a negative PST, the population-weighted mean was 95.1 percent. There was a change in antibiotic selection with inpatient penicillin allergy testing that was greater in the intensive care unit than in the general inpatient population (77.97 versus 54.73 percent; P < 0.01). There were reports of increased prescription of penicillin (range, 9.9 to 49 percent) and cephalosporin (range, 10.7 to 48 percent), while use of vancomycin and fluoroquinolone decreased. In four studies, inpatient penicillin allergy testing was associated with decreased health care cost.

"Inpatient penicillin allergy testing is safe and effective in ruling out penicillin allergy," the authors write. "Patients with a documented penicillin allergy who require penicillin should be tested during hospitalization given its benefit for individual patient outcomes and antibiotic stewardship."

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