Safety and effectiveness of a preoperative allergy clinic in decreasing vancomycin use in patients with a history of penicillin allergy.
BACKGROUND
We developed a clinical pathway to optimize the use of antimicrobials by decreasing vancomycin use in preoperative patients with a history of penicillin allergy.


OBJECTIVE
To decrease the use of vancomycin in surgical patients with a self-reported penicillin allergy.


METHODS
In June 2002, same-day allergy consultation and penicillin skin testing were made available for preoperative patients with self-reported penicillin allergy at the preoperative evaluation (POE) clinic. We reviewed the penicillin allergy skin test results, recommendations, and beta-lactam antibiotic administration outcomes from July 1, 2002, to September 16, 2003.


RESULTS
A total of 1,204 of 11,819 patients were evaluated for beta-lactam allergy at the POE clinic. Of these, 1,120 were approved by the institutional review board for inclusion in the study and 9 were excluded from the study. Of the remaining 1,111 patients, 1,030 (93%) underwent skin testing for penicillin allergy. Forty-three (4%) had a positive skin test result to penicillin. A total of 947 (85%) of the 1,111 patients with a history of beta-lactam allergy were advised to use a beta-lactam antibiotic, and 164 (15%) were advised to avoid beta-lactams. A total of 955 patients (86%) actually received preoperative antibiotics. Of these 955 patients, 716 (75%) received cefazolin, and only 149 (16%) received vancomycin compared with 30% historical controls (P < .01). Among the patients with a negative penicillin skin test result who received a cephalosporin, 5 (0.7%) of 675 experienced an adverse drug reaction to a cephalosporin.


CONCLUSIONS
Establishment of a clinical pathway in a preoperative clinic that includes allergy consultation and penicillin skin testing reduced vancomycin use to only 16% in surgical patients with a history of beta-lactam allergy.
Park
Miguel
M
Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. park.miguel@mayo.edu
Markus
Patricia
P
Matesic
Damir
D
Li
James T C
JT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002437:Cefazolin / Q000009:adverse effects / Q000627:therapeutic use; D002443:Ceftriaxone / Q000009:adverse effects / Q000627:therapeutic use; D002511:Cephalosporins / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D019091:Critical Pathways; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects / Q000276:immunology*; D011300:Preoperative Care / Q000379:methods; D012882:Skin Tests; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*; D047090:beta-Lactams / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D047090:beta-Lactams; D002981:Clindamycin; D002939:Ciprofloxacin; D014640:Vancomycin; D002443:Ceftriaxone; D002437:Cefazolin