title: A real-time prospective evaluation of clinical pharmaco-economic impact of diagnostic label of 'penicillin allergy' in a UK teaching hospital.
abstract: OBJECTIVE
  To perform a pharmaco-economic analysis of prescribing alternative antibiotics in patients with a diagnostic label of 'penicillin allergy' and assess whether collation of information from a structured history and liaison with the family physician could reduce costs.
  
  
  METHODS
  A prospective pro-forma-based interview of randomly selected in-patients and their family physician was used to assess the validity of the diagnostic label of 'penicillin allergy'. Cost analysis of prescription of alternative antibiotics was performed and compared with first-line agents.
  
  
  RESULTS
  102 patients were assessed and only 40% (n=41) were found to have a history consistent with penicillin hypersensitivity, 40% (n=41) were likely 'not allergic' and 20% (n=20) had 'indeterminate' reactions. Total cost of antibiotics prescribed for patients with penicillin allergy was 1.82-2.58-fold higher than for first-line antibiotics.
  
  
  CONCLUSIONS
  Obtaining a structured history from the patient and family physician alone can enable an accurate identification of penicillin allergy status. Total acquisition cost of second-line antibiotics is higher than if these patients were prescribed first-line antibiotics.
authors.affiliation: Department of Microbiology, Birmingham Heartlands Hospital, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Allergy and Immunology, Birmingham Heartlands Hospital, Birmingham, UK University of Warwick and University of Birmingham, Birmingham, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: Krishna
authors.affiliation: Pharmacy Department, Birmingham Heartlands Hospital, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Razaq
authors.affiliation: Department of Microbiology, Birmingham Heartlands Hospital, Birmingham, UK.
authors.forename: D
authors.initials: D
authors.lastname: Pillay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000191:economics*; D003365:Costs and Cost Analysis; D004342:Drug Hypersensitivity / Q000191:economics* / Q000453:epidemiology; D005260:Female; D006784:Hospitals, Teaching / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects* / Q000191:economics; D011446:Prospective Studies; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins
keywords: ANAPHYLACTIC REACTIONS; ANTIBIOTICS; IMMUNOLOGY