Reduction of vancomycin use in orthopedic patients with a history of antibiotic allergy.
OBJECTIVE
To reduce prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surgery by using a targeted allergy consultation and penicillin allergy skin testing.


METHODS
The participants in this practice improvement study were patients with a history of penicillin or cephalosporin allergy who were scheduled for elective orthopedic surgery and referred by orthopedic surgeons for allergy consultation and penicillin allergy skin testing between September 22, 1998, and April 15, 1999. The primary outcome measure was the percentage of participants who received prophylactic cefazolin during the study period compared with historical controls.


RESULTS
Of the 60 study patients, 59 received a penicillin allergy skin test, 58 underwent orthopedic surgery, and 55 received antibiotic prophylaxis. Fifty-five patients had a history of allergy to penicillin, a cephalosporin, or both, and 5 had a history of nonspecific antibiotic allergy. Of the 59 patients, 55 (93%) had negative penicillin allergy skin test results. Fifty-four (90%) of the 60 patients were given clearance by the allergist to receive cefazolin. Of the 55 study patients who received antibiotic prophylaxis, 6 (11%) received vancomycin compared with 38 (30%) of 127 historical controls (P < or = .05). None of the study patients had an immediate reaction to cefazolin or to vancomycin.


CONCLUSIONS
Prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surgery can be reduced by a targeted allergy consultation and penicillin allergy skin testing.
Li
J T
JT
Division of Allergy and Outpatient Infectious Disease and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Markus
P J
PJ
Osmon
D R
DR
Estes
L
L
Gosselin
V A
VA
Hanssen
A D
AD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data* / Q000639:trends; D002511:Cephalosporins / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D004363:Drug Utilization / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010406:Penicillins / Q000009:adverse effects*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011300:Preoperative Care / Q000379:methods*; D012017:Referral and Consultation; D012882:Skin Tests; D017749:Total Quality Management; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D014640:Vancomycin