World AMR Awareness Week (WAAW)- Antimicrobials And Untrue/Spurious Allergy

November 22, 2023

WAAW aims to raise awareness of antimicrobial resistance (AMR) – one of the leading risks to human health.

Today’s theme is ANTIMICROBIALS AND UNTRUE/SPURIOUS ALLERGY

A penicillin (or related beta-lactam) is usually the safest and most effective treatment option. However, around 10% of inpatients have a “penicillin allergy” listed in their clinical notes.

• The vast majority of people with a “penicillin allergy” have not experienced an allergic reaction; often just an adverse reaction such as gastric upset or nausea.
• Many reactions have occurred >10 years ago with details not documented/recalled.
• Spurious allergy labels can prevent patients from receiving optimal treatment.
  • Often more likely to cause adverse drug reactions.
  • Select for resistant organisms such as difficile, VRE and MRSA.
  • Associated with longer hospitals stays and greater costs.

It is imperative that the details of any allergies are fully documented as per NICE guidance (CG183) and reviewed critically when prescribing antimicrobials. Non-immunological reactions should not automatically contraindicate a penicillin or related antibiotic.

Refer patients to Immunology at City Hospital if they:

• Can only be treated by a beta‑lactam antibiotic OR
• Are likely to need beta‑lactam antibiotics frequently in the future

Consider referring if they have suspected allergies to beta‑lactam antibiotics and at least 1 other class of antibiotic.

Special Considerations

Patients with severe hypersensitivity syndromes – like Stevens-Johnson syndrome, toxic epidermal necrolysis, serum sickness, acute interstitial nephritis, haemolytic anaemia, and drug rash with eosinophilia and systemic symptoms (DRESS)—should not use the offending drug in the future.

For more details on penicillin allergy see “Assessment and Management of Penicillin Allergy in Adults and Children” on connect.