Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts

To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context. Data were collected at two English hospital NHS tr...

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Bibliographic Details
Published in:BMJ open 2019-03, Vol.9 (2), p.e026624
Main Authors: Phillips, Cameron J, Gilchrist, Mark, Cooke, Fiona J, Franklin, Bryony D, Enoch, David A, Murphy, Michael E, Santos, Reem, Brannigan, Eimear T, Holmes, Alison H
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Allergies
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Antibiotics
Cohort Studies
Community-Acquired Infections - drug therapy
Cross Infection - drug therapy
Documentation
Documentation - statistics & numerical data
Drug Hypersensitivity - epidemiology
Drug Hypersensitivity - etiology
Electronic health records
Female
Guideline Adherence
Health services
Hospitals
Humans
Immunology (Including Allergy)
Logistic Models
Male
Middle Aged
Multivariate Analysis
Patients
Penicillin
Penicillins - adverse effects
Penicillins - therapeutic use
Pneumonia
Pneumonia - drug therapy
Practice Guidelines as Topic
Practice Patterns, Physicians' - statistics & numerical data
Soft Tissue Infections - drug therapy
State Medicine
United Kingdom
Urinary tract diseases
Urinary tract infections
Urinary Tract Infections - drug therapy
Urogenital system
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Summary:To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context. Data were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017. Cohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report. Inpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs. A total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73) p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2018-026624