Return to sender: the need to re-address patient antibiotic allergy labels in Australia and New Zealand

Intern Med J. 2016 Nov;46(11):1311-1317. doi: 10.1111/imj.13221.

Abstract

Background/aim: Antibiotic allergies are frequently reported and have significant impacts upon appropriate prescribing and clinical outcomes. We surveyed infectious diseases physicians, allergists, clinical immunologists and hospital pharmacists to evaluate antibiotic allergy knowledge and service delivery in Australia and New Zealand.

Methods: An online multi-choice questionnaire was developed and endorsed by representatives of the Australasian Society of Clinical Immunology and Allergy (ASCIA) and the Australasian Society of Infectious Diseases (ASID). The 37-item survey was distributed in April 2015 to members of ASCIA, ASID, the Society of Hospital Pharmacists of Australia and the Royal Australasian College of Physicians.

Results: Of 277 respondents, 94% currently use or would utilise antibiotic allergy testing (AAT) and reported seeing up to 10 patients/week labelled as antibiotic-allergic. Forty-two per cent were not aware of or did not have AAT available. Most felt that AAT would aid antibiotic selection, antibiotic appropriateness and antimicrobial stewardship (79, 69 and 61% respectively). Patients with the histories of immediate hypersensitivity were more likely to be referred than those with delayed hypersensitivities (76 vs 41%, P = 0.0001). Lack of specialist physicians (20%) and personal experience (17%) were barriers to service delivery. A multidisciplinary approach was a preferred AAT model (53%). Knowledge gaps were identified, with the majority overestimating rates of penicillin/cephalosporin (78%), penicillin/carbapenem (57%) and penicillin/monobactam (39%) cross-reactivity.

Conclusions: A high burden of antibiotic allergy labelling and demand for AAT is complicated by a relative lack availability or awareness of AAT services in Australia and New Zealand. Antibiotic allergy education and deployment of AAT, accessible to community and hospital-based clinicians, may improve clinical decisions and reduce antibiotic allergy impacts. A collaborative approach involving infectious diseases physicians, pharmacists and allergists/immunologists is required.

Keywords: adverse drug reaction; antibiotic allergy; antibiotic allergy testing; antimicrobial stewardship; skin testing.

MeSH terms

  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / classification
  • Australia
  • Clinical Competence
  • Cross Reactions
  • Demography
  • Drug Hypersensitivity / epidemiology*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Hypersensitivity, Delayed / epidemiology
  • Hypersensitivity, Immediate / epidemiology
  • New Zealand
  • Pharmacists*
  • Physicians*
  • Referral and Consultation
  • Skin Tests / statistics & numerical data

Substances

  • Anti-Bacterial Agents