Blog | Friday, January 25, 2019

Penicillin allergy, probably not

The current issue of JAMA has a wonderful review of penicillin allergy. This conclusion is important:
Many patients report they are allergic to penicillin but few have clinically significant reactions. Evaluation of penicillin allergy before deciding not to use penicillin or other β-lactam antibiotics is an important tool for antimicrobial stewardship.

This concept has great importance. Almost every time I give a pharyngitis talk, someone asks me about second-line antibiotics for patients with “penicillin allergy”. Since penicillin (or amoxicillin) work well against group A strep, group C/G strep and Fusobacterium necrophorum, we want to use a penicillin as our first-line antibiotic.

The review and the wonderful podcast on the topic, make me now want to urge primary care physicians and student health centers should test patients who believe that they are pen allergic prior to needing penicillin.

Given the usefulness of penicillins for significant inpatient infections, we should be testing all “pen allergic” patients in advance. Penicillins remain very important antibiotics and we have inadvertently labelled too many patients as allergic.

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.