TY - JOUR
T1 - Penicillin Allergy Maybe Not? the Military Relevance for Penicillin Testing and De-labeling
AU - Lee, Rachel U.
AU - Banks, Taylor A.
AU - Waibel, Kirk H.
AU - Rodriguez, Rechell G.
N1 - Funding Information:
Executive Order 13676 was issued in 2014 to combat antibiotic-resistant bacteria, followed by the publication of a National Action Plan in 2015. This in turn led to the Joint Commission requirement for antibiotic stewardship standards in 2016. Antibiotic Stewardship Programs (ASPs) were developed by the Society for Healthcare Epidemiology of America and the Infectious Diseases Societies, supported by the Centers for Disease Control and Prevention. All acute care hospitals participating in Medicaid and Medicare are now required to implement ASPs, including all military treatment facilities (MTFs). MTFs are currently in the process of developing ASP programs depending on the size of their facilities, services provided and resources available. Penicillin allergy testing and verification will be an important part of this program to avoid unnecessary use of broader spectrum antibiotics and suboptimal treatment regimens, as well as to decrease the rising number of drug-resistant organisms.
Publisher Copyright:
© 2018 Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Introduction Penicillin allergy is the most common drug allergy reported. About 8-10% of individuals in the USA have a documented penicillin allergy, yet 90% are not truly allergic to penicillin. A penicillin allergy "label" results in increased antibiotic-related adverse reactions and increased health care costs, thus impacting the overall "readiness" of the military. Materials and Methods A review of the current literature and approaches to penicillin allergy and "de-labeling" a patient who reports penicillin allergy was conducted and future strategies to identify and assess military beneficiaries were outlined. Military allergists had a formal discussion at the Tri-service Military Allergy Immunology Assembly regarding the state of penicillin allergy testing in military allergy clinics. Results A PubMed search yielded 5,775 results for "penicillin allergy" and 484 results for "penicillin allergy testing." There were two formalized penicillin testing programs in the military treatment facilities. In 2017, the military trained nearly 165,000 new recruits. If 5-10% reported a penicillin allergy and 90% were de-labeled, that would yield a $15-30 million cost savings annually. Further, de-labeling of the 9.4 million active duty, beneficiaries and retirees with a 90% success rate could result in even greater savings for the military health care system. Conclusion A penicillin allergy label is a risk to military readiness secondary to associated increases in the length of hospitalizations and emergency department and medical visits. Penicillin de-labeling is a simple intervention that can improve readiness, significantly decrease health care costs and prevent antibiotic resistance, as well as antibiotic-associated adverse events. The military allergist should be "front and center" providing expertise guidance and leadership for clinic and hospital-based penicillin de-labeling efforts which are nested within the antibiotic stewardship programs.
AB - Introduction Penicillin allergy is the most common drug allergy reported. About 8-10% of individuals in the USA have a documented penicillin allergy, yet 90% are not truly allergic to penicillin. A penicillin allergy "label" results in increased antibiotic-related adverse reactions and increased health care costs, thus impacting the overall "readiness" of the military. Materials and Methods A review of the current literature and approaches to penicillin allergy and "de-labeling" a patient who reports penicillin allergy was conducted and future strategies to identify and assess military beneficiaries were outlined. Military allergists had a formal discussion at the Tri-service Military Allergy Immunology Assembly regarding the state of penicillin allergy testing in military allergy clinics. Results A PubMed search yielded 5,775 results for "penicillin allergy" and 484 results for "penicillin allergy testing." There were two formalized penicillin testing programs in the military treatment facilities. In 2017, the military trained nearly 165,000 new recruits. If 5-10% reported a penicillin allergy and 90% were de-labeled, that would yield a $15-30 million cost savings annually. Further, de-labeling of the 9.4 million active duty, beneficiaries and retirees with a 90% success rate could result in even greater savings for the military health care system. Conclusion A penicillin allergy label is a risk to military readiness secondary to associated increases in the length of hospitalizations and emergency department and medical visits. Penicillin de-labeling is a simple intervention that can improve readiness, significantly decrease health care costs and prevent antibiotic resistance, as well as antibiotic-associated adverse events. The military allergist should be "front and center" providing expertise guidance and leadership for clinic and hospital-based penicillin de-labeling efforts which are nested within the antibiotic stewardship programs.
KW - antibiotic resistance
KW - antibiotic stewardship
KW - drug allergy
KW - penicillin allergy
KW - penicillin allergy de-labeling
UR - http://www.scopus.com/inward/record.url?scp=85062882308&partnerID=8YFLogxK
U2 - 10.1093/milmed/usy194
DO - 10.1093/milmed/usy194
M3 - Article
C2 - 30137597
AN - SCOPUS:85062882308
SN - 0026-4075
VL - 184
SP - E163-E168
JO - Military Medicine
JF - Military Medicine
IS - 3-4
ER -