Barriers to paediatric penicillin allergy de-labelling in UK secondary care : a regional survey
Abstract
Background: Incorrect penicillin allergy labels result in the use of inappropriately broad-spectrum antibiotics. De-labelling inaccurate penicillin allergy promotes antimicrobial stewardship and optimises prescribing practices. The objectives were to evaluate paediatric clinicians' knowledge and understanding of penicillin allergy and to identify barriers in tackling incorrect penicillin allergy labels. Methods: Paediatric clinicians from across the West Midlands of the UK were surveyed using an online, anonymised questionnaire between 1 August and 30 September 2021. Domains explored were (1) approach to penicillin allergy clinical vignettes, (2) knowledge of the impact of penicillin allergy labels, (3) frequency of allergy-focused history questions and (4) barriers in tackling incorrect penicillin allergy. Results: Responses were received from 307 paediatric clinicians across 12 hospitals. Sixty-one per cent would not prescribe a penicillin-based antibiotic if a family history of penicillin allergy was reported. There was an overall deficit in taking an allergy-focused history with only 36.5% inquiring about diagnostic confirmation. Absence, or lack of awareness of a referral pathway for antibiotic allergy evaluation (58.6%) and unfamiliarity of the indications for oral provocation testing (55%) were the most common reported barriers to penicillin allergy de-labelling. Fifty-one per cent would rather 'play it safe' than explore penicillin allergy confirmation as it is felt that alternative treatments were readily available. Conclusions: The deficiency in antibiotic allergy-focused history among paediatric clinicians highlights the need for better allergy education across all clinical grades. Pragmatic algorithms and clear referral pathways could address barriers faced by non-allergists in de-labelling incorrect penicillin allergy.
Citations
Altmetric:
Date
2022-12-19
Type
Article
Subject
Paediatrics
Collections
Citation
Maduemem K, Clark H, Sohal I, Dawson T, Makwana N; Paediatric Research Across the Midlands (PRAM) Network. Barriers to paediatric penicillin allergy de-labelling in UK secondary care: a regional survey. Arch Dis Child. 2023 May;108(5):363-366. doi: 10.1136/archdischild-2022-324564
Journal / Source Title
Archives of Disease in Childhood
DOI
10.1136/archdischild-2022-324564
PMID
36535750
Publisher
BMJ Publishing Group