Background: Beta-lactam antibiotic allergy labels are highly prevalent but rarely indicate an allergic intolerance. These patient-reported allergies lead to broad-spectrum antibiotic use, conferred resistance, increased expense, and adverse effects. Objective: To implement and assess the impact of a history-based clinical guideline that directs antibiotic management and beta-lactam allergy relabeling for patients reporting beta-lactam allergies. Methods: Patients with beta-lactam allergy labels were identified by our trained multidisciplinary team in diverse clinical settings. This quality improvement project was conducted to evaluate the safety and impact of the guideline on antibiotic use by comparing prescribing practices before and after guideline implementation. Results: A total of 79 patients with beta-lactam allergies were identified (penicillins-90, cephalosporins-10). After guideline implementation, outcomes of allergy relabeling included the following: (1) complete removal, indicating an unlikely true allergy (27); (2) updated to detail successfully tolerated beta-lactam courses (48); or (3) no change made to current label (25). Beta-lactam antibiotic courses before and after guideline implementation compared with total antibiotic courses: allergy removed (44 vs 70; P < .001), allergy updated (32 vs 68; P < .001), and no change (27 vs 41; P = .08). Compared with before guideline implementation, beta-lactam antibiotics were 3 times more likely to be prescribed after allergy assessment (odds ratio, 3.22; 95 confiConclusion: The implementation of the beta-lactam allergy clinical guideline resulted in most patients' allergy labels being removed or advantageously updated. These allergy label changes correlated with a substantial increase in the percentage of beta-lactam antibiotics prescribed. After guideline implementation, beta-lactam antibiotics had a 3-fold increased odds of being prescribed independent of allergy label outcome. Published by Elsevier Inc. on behalf of the American College of Allergy, Asthma Immunology.
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机译：背景：β-内酰胺类抗生素过敏标签非常普遍，但很少表明过敏不耐受。这些患者报告的过敏会导致广谱抗生素的使用、产生耐药性、增加费用和不良反应。目的：实施和评估基于病史的临床指南对报告β-内酰胺类过敏的患者进行抗生素管理和β-内酰胺类过敏重新标记的影响。方法：由我们训练有素的多学科团队在不同的临床环境中识别具有 β-内酰胺类过敏标签的患者。该质量改进项目旨在通过比较指南实施前后的处方实践来评估指南对抗生素使用的安全性和影响。结果：共发现79例β-内酰胺类过敏患者（青霉素-90%，头孢菌素-10%）。指南实施后，过敏重新标记的结果包括：（1）完全去除，表明不太可能真正的过敏（27%）;（2）更新为详细描述成功耐受的β-内酰胺疗程（48%）;或 （3） 未对当前标签进行更改 （25%）。指南实施前后的β-内酰胺类抗生素疗程与抗生素总疗程的比较：去除过敏（44% vs 70%;P < .001），过敏更新（32% vs 68%;P < .001），无变化（27% 对 41%;P = .08）。与指南实施前相比，过敏评估后开具β-内酰胺类抗生素的可能性增加了3倍（比值比，3.22;95%的浓度结论：β-内酰胺类过敏临床指南的实施导致大多数患者的过敏标签被删除或有利地更新。这些过敏标签的变化与β-内酰胺类抗生素处方百分比的大幅增加有关。指南实施后，β-内酰胺类抗生素的处方几率增加了 3 倍，与过敏标签结果无关。由爱思唯尔公司（Elsevier Inc.）代表美国过敏、哮喘和免疫学会（American College of Allergy， Asthma & Immunology）出版。
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