Multiple studies have described that persons with reported penicillin or another ß-lactam antibiotic allergy have higher rates of surgical-site infections, methicillin-resistant Staphylococcus aureus infections, and higher medical care usage ( 653, 662– 664). Moreover, penicillin allergy labels lead to the use of more expensive and less effective drugs and can result in adverse consequences, including longer length of hospital stay and increased risk for infection. The presence of a penicillin allergy label considerably reduces prescribing options for affected patients. Patients often are incorrectly labeled as allergic to penicillin and are therefore denied the benefit of a ß-lactam therapy. The prevalence of reported penicillin allergy in low-income countries is unknown however, limited data indicate that penicillin is one of the most frequently reported antibiotic allergies ( 661). Penicillin allergy is often overreported, with the majority of patients who report penicillin allergy able to tolerate the medication ( 660). One large study in an STI clinic revealed that 8.3% of patients reported penicillin or another ß-lactam antibiotic allergy ( 659). population and higher among hospital inpatients and residents in health care–related facilities ( 655– 658). Prevalence of reported allergy to penicillin is approximately 10% among the U.S. For patients with a diagnosis of gonorrhea and a concomitant reported allergy to penicillin, ceftriaxone is often avoided, even though the cross-reactivity between penicillin allergy and third-generation cephalosporins is low ( 652– 654). pallidum chromosomal mutations associated with azithromycin and other macrolide resistance and documented treatment failures in multiple geographic areas, azithromycin should not be used as treatment for syphilis ( 23,606–608). For extragenital site infections, especially pharyngeal, failure rates of nonceftriaxone regimens can be substantial. Ceftriaxone, a third-generation cephalosporin, is recommended for gonorrhea treatment. Penicillin is recommended for all clinical stages of syphilis, and no proven alternatives exist for treating neurosyphilis, congenital syphilis, or syphilis during pregnancy. Evaluation of penicillin allergy before deciding not to use penicillin or other β-lactam antibiotics is an important tool for antimicrobial stewardship.Penicillin and other ß-lactam antibiotics have a crucial role in treating STIs. Many patients report they are allergic to penicillin but few have clinically significant reactions. Clinicians performing penicillin allergy evaluation need to identify what methods are supported by their available resources. Moderate-risk patients can be evaluated with penicillin skin testing, which carries a negative predictive value that exceeds 95% and approaches 100% when combined with amoxicillin challenge. Direct amoxicillin challenge is appropriate for patients with low-risk allergy histories. Broad-spectrum antimicrobial agents also increase the risk of developing Clostridium difficile (also known as Clostridioides difficile) infection. The goals of antimicrobial stewardship are undermined when reported allergy to penicillin leads to the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance, including increased risk of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus. A high-risk history includes patients who have had anaphylaxis, positive penicillin skin testing, recurrent penicillin reactions, or hypersensitivities to multiple β-lactam antibiotics. A moderate-risk history includes urticaria or other pruritic rashes and reactions with features of IgE-mediated reactions. Although many patients report that they are allergic to penicillin, clinically significant IgE-mediated or T lymphocyte-mediated penicillin hypersensitivity is uncommon (10 years) unknown reactions without features suggestive of an IgE-mediated reaction. Many patients report allergies to these drugs that limit their use, resulting in the use of broad-spectrum antibiotics that increase the risk for antimicrobial resistance and adverse events.Īpproximately 10% of the US population has reported allergies to the β-lactam agent penicillin, with higher rates reported by older and hospitalized patients. Β-Lactam antibiotics are among the safest and most effective antibiotics.
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