Impact of antibiotic allergy labels on patient outcomes in a tertiary paediatric hospital
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Date
2022-03-01
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British Journal of Clinical Pharmacology
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WILEY
Melbourne Authors
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Biochemistry and Pharmacology
Paediatrics (RCH)
Paediatrics (RCH)
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Journal Article
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Catalano, A. C., Pittet, L. F., Choo, S., Segal, A., Stephens, D., Cranswick, N. E. & Gwee, A. (2022). Impact of antibiotic allergy labels on patient outcomes in a tertiary paediatric hospital. British Journal of Clinical Pharmacology, 88 (3), pp.1107-1114. https://doi.org/10.1111/bcp.15038.
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Abstract
AIMS: Antibiotic allergies are reported in 5-15% of children. This study aimed to evaluate the impact of common β-lactam antibiotic allergy labels (AALs) on hospital treatment, focusing on length of stay and appropriateness of antibiotic prescribing. METHODS: This was a retrospective cohort study over 21 months at the Royal Children's Hospital Melbourne, Australia. A subset of children with the most common β-lactam allergies, and who required admission for intravenous antibiotics over a 12-month period, was analysed for appropriateness of prescribing. Non-allergic patients were matched to evaluate associations between AALs and hospital treatment. RESULTS: There were 98 912 children admitted over the study period, of whom 938 (1%) had at least one AAL on first admission. Of all encounters, 5145 (2.5%) were for children with AALs. The most common AALs were to amoxicillin and amoxicillin-clavulanic acid combinations (40.8%), cefalexin (14.4%) and trimethoprim-sulfamethoxazole (9.7%). For the subset, there were 66 admissions for children who required intravenous antibiotics. Documentation was adequate for 27% of AALs. Inappropriate prescribing occurred in almost half (47%). Hospital stay was longer for children with AALs (median 4.7 days; IQR 2.3-9.2) compared to non-allergic controls (median 3.9 days; IQR 1.9-6.8; P = .02). Children with AALs were more likely to receive restricted antibiotics (aOR 3.03; 95% CI, 1.45-6.30; P = .003). CONCLUSION: This is the first study to demonstrate high rates of inappropriate prescribing in children with AALs. Children with AALs were significantly more likely to receive restricted antibiotics and had a longer length of stay compared with non-allergic controls.