title: Physician approaches to beta-lactam use in patients with penicillin hypersensitivity.
abstract: Beta-lactam antibiotics are widely used, but hypersensitivity reactions are common and difficult to manage. This study was designed to identify lack of knowledge regarding the safe use of alternative beta-lactams in penicillin-allergic patients and assess management differences between allergists and nonallergists. An electronic physician survey was sent to 623 providers in allergy, internal medicine, pediatrics, and family medicine, querying beta-lactam use in patients with a history of penicillin allergy. A total of 110 (17.7%) surveys were completed. For patients with a prior maculopapular rash to penicillin, most providers were uncomfortable prescribing penicillins again, although they would use other beta-lactams. In patients with an exfoliative dermatitis to penicillin, 46% of responders would not prescribe any beta-lactam again. For patients with a positive skin test to penicillin, only 45.1% of nonallergists were comfortable prescribing monobactams versus 62.5% of allergists; 30.3% of all responders would give a carbapenem. In patients with urticaria to penicillin, pediatricians were the most comfortable prescribing third- or fourth-generation cephalosporins. Providers (both allergists and nonallergists) were unfamiliar with the safety of prescribing penicillin in patients with history of maculopapular rash, the safety of monobactams, and low cross-reactivity with carbapenems in penicillin-allergic individuals. Nonallergists were also unfamiliar with the usefulness of penicillin skin testing. Improved education is needed to address these areas. Additionally, we found variability in responses regarding exfoliative dermatitis and comfort prescribing cephalosporins in patients with suspected IgE-mediated drug allergy to penicillin, highlighting the need for additional research in these areas.
authors.affiliation: Department of Medicine, Section of Allergy and Immunology, Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Hershey, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Prematta
authors.forename: Shenil
authors.initials: S
authors.lastname: Shah
authors.forename: Faoud T
authors.initials: FT
authors.lastname: Ishmael
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D004501:Education, Medical; D006801:Humans; D008997:Monobactams / Q000627:therapeutic use; D010406:Penicillins / Q000009:adverse effects*; D010820:Physicians; D012882:Skin Tests; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D008997:Monobactams; D010406:Penicillins; D047090:beta-Lactams