Implementation of a pharmacist-led penicillin allergy de-labelling service in a public hospital.

BACKGROUND: Inaccurate allergy labelling results in inappropriate antimicrobial management of the patient, which may affect clinical outcome, increase the risk of adverse events and increase costs. Inappropriate use of alternative antibiotics has implications for antimicrobial stewardship programmes and microbial resistance. METHODS: All adult inpatients labelled as penicillin allergic were identified and screened for eligibility by the study pharmacist. An accurate allergy and medication history was taken. Patients were 'de-labelled', underwent oral challenge or were referred to an immunology clinic, if study criteria were met. All patients included in the study were followed-up 1 year after intervention. RESULTS: Two hundred and fifty eligible patients with a label of 'penicillin allergy' were identified. The prevalence of reported penicillin allergy at Middlemore Hospital was 11%. We found that 80% of study patients could be 'de-labelled'. Of those, 80% were 'de-labelled' after an interview with the pharmacist alone, 16% had an uneventful oral challenge and 4% were deemed to be inappropriately labelled after referral to an immunology clinic. Appropriately labelled patients accounted for 20% of the study population. Changes to inpatient antibiotic therapy were recommended in 61% of 'de-labelled' patients, of which no patients had adverse events after commencing on penicillin antibiotics. At the 1 year follow-up, 98% of patients who were 'de-labelled' had no adverse events to repeated administration of penicillin antibiotics. CONCLUSIONS: This study showed that a pharmacist-led allergy management service is a safe option to promote antimicrobial stewardship and appropriate allergy labelling.

Socioeconomic factors correlating with community antimicrobial prescribing.

BACKGROUND: Increasing antimicrobial resistance is a serious concern in New Zealand and worldwide. Antimicrobial resistance is tied to increased community antimicrobial consumption. Investigation of the drivers of antimicrobial prescribing in different locales is needed so that targeted interventions can be devised. Counties Manukau District Health Board (CMDHB) serves a diverse, relatively socio-economically deprived population that has the highest rate of community antimicrobial prescribing in New Zealand. We hypothesise that socio-economic factors are important in determining much of the prescribing of antimicrobials in the CMDHB population. METHODS: We collected data on the number of antibacterial prescriptions per person in each pre-defined geographical Area Unit in the CMDHB community in 2013, and compared these with demographic and socioeconomic parameters collected in the 2013 New Zealand census. Simple and multiple linear regression analyses were used to identify factors that correlated with antimicrobial prescribing. RESULTS: Multiple regression analysis showed that antimicrobial prescribing was strongly associated with a higher ratio of number of people to bedrooms in a dwelling (an index of crowding), with some added association with Maori ethnicity. When these factors were accounted for, there was no significant added influence from a range of other factors such as income, smoking or educational qualifications. CONCLUSIONS: Antimicrobial prescribing may be influenced by different factors within different communities. It is important to target the determinants of antimicrobial prescribing when addressing the issue of high community antimicrobial consumption. In the CMDHB community, crowding in homes is associated with higher rates of antimicrobial prescribing. This association may be because crowding directly increases infection rates, or that crowding serves as a proxy for other factors yet to be identified. Further investigation of the determinants of antimicrobial prescribing is needed.