Preoperative evaluation of patients with history of allergy to penicillin: comparison of 2 models of practice.
OBJECTIVE
To study whether allergy consultation and penicillin allergy skin testing affects the selection of antibacterial prophylaxis perioperatively in surgical patients with history of allergy to penicillin (HOAP).


METHODS
From January 1 through June 30, 2004, we compared 2 different models of practice at our institution. At the Preoperative Evaluation Clinic (POEC), all patients with HOAP are evaluated by an allergist and undergo skin testing for allergy to penicillin. At other (non-POEC) preoperative evaluation settings (OPES), patients with HOAP do not undergo allergy consultation and penicillin skin testing before surgery. Of the 4889 patients screened at the POEC during the study period, 412 consecutive patients with HOAP were included in the study. Of the 416 patients screened at OPES, 69 consecutive patients with HOAP were studied. Logistic regression was used to assess whether allergy consultation was associated with the choice of antibiotic for antibacterial prophylaxis perioperatively, after adjusting for age, sex, and type of surgery.


RESULTS
Perioperative cephalosporin use was greater among patients screened at POEC vs those screened at OPES (70% vs 39%, P<.001 unadjusted; P=.04 adjusted for age, sex, and type of surgery). Vancomycin use was lower for patients screened at POEC vs those screened at OPES (10% vs 28%, P<.001 unadjusted; P=.03 adjusted).


CONCLUSIONS
For patients with HOAP, evaluation at the POEC was associated with increased use of cephalosporin and decreased use of vancomycin.
Division of Allergic Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. frigas.evangelo@mayo.edu
Evangelo
E
Frigas
Miguel A
MA
Park
Bradly J
BJ
Narr
Gerald W
GW
Volcheck
David R
DR
Danielson
Patricia J
PJ
Markus
Kristin E Kloos
KE
Olson
Darrell R
DR
Schroeder
Hirohito
H
Kita
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D002511:Cephalosporins / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000009:adverse effects*; D019990:Perioperative Care; D011300:Preoperative Care; D012882:Skin Tests / Q000379:methods*; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin; D010400:Penicillin G