Antibiotic allergy labels in hospitalized and critically ill adults: A review of current impacts of inaccurate labelling

Abstract

Antibiotic allergy labels (AALs) are reported by approximately 20% of hospitalized patients, yet over 85% will be negative on formal allergy testing. Hospitalized patients with an AAL have inferior patient outcomes, increased colonization with multidrug-resistant organisms and frequently receive inappropriate antimicrobials. Hospitalized populations have been well studied but, to date, the impact of AALs on patients with critical illness remains less well defined. We review the prevalence and impact of AALs on hospitalized patients, including those in in critical care.

Keywords: acute care; antimicrobial allergy; antimicrobial stewardship; penicillin allergy; skin testing.

Figure 1

Proposed algorithm for assessment and management of patients with antibiotic allergy label in ICU. A proposed algorithm to assist with the management of penicillin antibiotic allergy labels that are admitted to the intensive care unit who require antibiotics 13, 41, 65. ICU, intensive care unit; MPE, maculopapular exanthem; ADR, adverse drug reaction; IV, intravenous; SJS, Stevens–Johnston syndrome; TEN, toxic epidermal necrosis; AAT, antibiotic allergy testing. ^Cautious of drugs with antihistamine properties, including antidepressants and cyclizine, *Refer to allergy testing guidelines for drug selection, doses and administration technique