Cephalosporin use in penicillin-allergic patients: a survey of otolaryngologists and literature review.
OBJECTIVE
This study investigated the differences between the standard guidelines and the practice patterns of otolaryngologists in managing "penicillin-allergic" patients. A major goal was to identify factors influencing an otolaryngologist's choice of antibiotic.


METHODS
Cross-sectional survey.


METHODS
Four hundred seventy members of the American Society of Pediatric Otolaryngologists (ASPO) and 150 general otolaryngologists from the Florida Society of Otolaryngology (FSO) were surveyed.


RESULTS
Ninety-six ASPO members (20.4%) and 22 members of FSO (14.6%) responded. When asked about the management of a pediatric patient with acute otitis media and a history of a nonsevere immunoglobulin E (IgE)-mediated amoxicillin allergy, 54% of ASPO respondents indicated they would initiate guideline-recommended cefdinir, whereas only 27% of FSO respondents chose cefdinir (P = .02). Otolaryngologists who are fellowship trained in pediatrics or have pediatric-focused practices were significantly more likely to prescribe cefdinir. Overall, 57% of respondents indicated that they were familiar with the literature regarding the cross-reactivity of β-lactams, but only 25% of respondents felt that they could easily differentiate a potentially life-threatening IgE-mediated allergy from a non-IgE-mediated drug intolerance.


CONCLUSIONS
The data show differences between the current recommendations and the behavior of otolaryngologists. Pediatric otolaryngologists were more familiar with the guideline-recommended therapy, likely from their frequent exposure to patients requiring a β-lactam. Nevertheless, most otolaryngologists could benefit from increased awareness of the current literature. Patients may be receiving less than optimal medication management due to a misidentification of those at risk of life- threatening allergic cross-reactions.


METHODS
NA
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.
Michael J
MJ
Persky
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.
Scott A
SA
Roof
Department of Population Health, New York University School of Medicine, New York, New York, U.S.A.|Department of Environmental Medicine, New York University School of Medicine, New York, New York, U.S.A.
Yixin
Y
Fang
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.
Daniel
D
Jethanamest
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.
Max M
MM
April
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use*; D004342:Drug Hypersensitivity; D006801:Humans; D010033:Otitis Media / Q000188:drug therapy*; D010036:Otolaryngology / Q000706:statistics & numerical data*; D010406:Penicillins / Q000009:adverse effects*; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins
Allergy; antibiotic; clinical practice guidelines; evidence-based medicine; immunology; pen-allergic; penicillin