title: Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital.
abstract: BACKGROUND
  Prescribing antibiotics to patients with a history of penicillin allergy is common in clinical practice. Opting for non-beta-lactam antibiotics has its inconveniences and is often unnecessary, because most of these patients are in fact not allergic.
  
  
  OBJECTIVE
  This study aimed to determine how physicians in a large Canadian tertiary-care academic hospital without allergists on staff treat patients with a history of penicillin allergy.
  
  
  METHODS
  A retrospective study was conducted during a 1-year period among all patients hospitalized in the intensive care unit, coronary care unit, and internal medicine wards. Files of patients with a record of penicillin allergy were reviewed to assess the need for antibiotics during their hospitalization and the decision-making process underlying the choice of antibiotic. The additional costs of alternative antibiotics were calculated.
  
  
  RESULTS
  The files of 1738 patients admitted over a 1-year period were hand reviewed. A history of penicillin allergy was found in 172 patients (9.9%). The allergic reaction was described in only 30% of cases and left unmentioned in 20.7%. Beta-lactam antibiotics were used on 56 occasions despite a history of penicillin allergy. The use of alternative antibiotics in place of the beta-lactam standard of care carried an additional cost of $15,672 Canadian.
  
  
  CONCLUSIONS
  Alleged penicillin allergy is common among hospitalized patients and leads to substantial additional costs. Poor documentation of penicillin allergy likely reflects a lack of knowledge on this issue in the medical community, which impairs optimal treatment of these patients. Increased education on this matter is needed, and allergists on staff could be part of the solution.
authors.affiliation: Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada; Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada. Electronic address: matthieu.picard@umontreal.ca.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Picard
authors.affiliation: Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada; Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bégin
authors.affiliation: Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada.
authors.forename: Hugues
authors.initials: H
authors.lastname: Bouchard
authors.affiliation: Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cloutier
authors.affiliation: Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lacombe-Barrios
authors.affiliation: Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Paradis
authors.affiliation: Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Des Roches
authors.affiliation: Department of Medicine, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Quebec, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Laufer
authors.affiliation: Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Paradis
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D000368:Aged; D003325:Coronary Care Units / Q000191:economics; D003625:Data Collection; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007388:Internal Medicine / Q000191:economics; D008297:Male; D010406:Penicillins / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D011792:Quebec; D012008:Recurrence; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000191:economics
chemical_list: D010406:Penicillins
keywords: Allergist; Antibiotic; Cost-effectiveness; Drug allergy; Education; Intensive care unit; Internal medicine; Management; Penicillin allergy; Quality of care