Antibiotic Allergic Patients: A New Target for Antimicrobial Stewardship Programs?

By Guillaume Beraud
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Comment on: Trubiano J, Phillips E. Antimicrobial stewardshipʼs new weapon? A review of antibiotic allergy and pathways to “de-labeling.” Curr Opin Infect Dis. 2013 Dec;26(6):526–37.
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  • Antibiotic allergy labels are easily assigned and maintained, although on an imprecise and fuzzy way..
  • Theses labels are often misrepresented and leads to sub-optimal choice for antibiotics, which could have a negative impact both on ecology and on patient outcomes. Just think about using quinolones instead of a penicillin…
  • Combined antibiotic allergy testing has a very high negative predictive value.
  • Integrating an antibiotic allergy program into an antimicrobial stewardship program could help physicians to “de-label” patients and could be another “strong weapon” in the armamentarium of antimicrobial stewardship.
  • Some preliminary studies shown that antibiotic allergy programs reduces antimicrobial use, patient mortality and hospitalization cost. It should be confirmed by randomized studies but seems an easy and useful way to improve our antimicrobial stewardship programs.
  • The following graph propose a model for an integrated antimicrobial stewardship and antibiotic allergy de-labeling program.

 

Proposed algorithm for the management of patients labeled with “Antibiotic Allergy”. A proposed model for an integrated antimicrobial stewardship and antibiotic allergy de-labeling program. a) Alternative: In patients with low clinical suspicion of antibiotic allergy or previous negative in-vivo testing, immediate re-challenge should be considered. In patients with non-IgE-mediated allergy (confirmed or nonconfirmed) to a b-lactam antibiotic, avoid antibiotics that share an identical R1 or R2 group side chain (Tables 2 and 3). In patients with proven isolated IgE-mediated b-lactam antibiotic allergy or high clinical suspicion prior to in-vivo testing, preferred antibiotic therapies include carbapenems, aztreonam, fluoroquinolone, glycopeptides, or lincosamide.

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