• Merin Kuruvilla, Marybeth Sexton, Zanthia Wiley, Terry Langfitt, Grant C Lynde, and Francis Wolf.
• Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, Ga. Electronic address: merin.kuruvilla@emoryhealthcare.org.
• J Allergy Clin Immunol Pract. 2020 Apr 1; 8 (4): 1316-1322.

BackgroundPatients with penicillin allergy labels often receive alternative antibiotics for perioperative prophylaxis, as opposed to first-line cephalosporins (cefazolin/cefuroxime). Provider misconceptions about the risk of cross-reactivity likely drive this prescribing behavior, which is problematic because of its association with increased risk of surgical-site infections.ObjectiveTo develop, implement, and assess the safety of a streamlined approach to perioperative antibiotic selection for surgical patients with a penicillin allergy label, to reduce the use of second-line antibiotics.MethodsA multidisciplinary task force developed an institutional algorithm for antibiotic selection in penicillin-allergic surgical patients. The percentage of patients receiving a first-line cephalosporin was compared before and after algorithm utilization. The safety of this approach was assessed via chart review of all patients who received epinephrine or diphenhydramine in the operating room, or diphenhydramine within 24 hours postoperatively, assessing for any adverse reactions to cephalosporin administration.ResultsBetween September 2016 and May 2019, 9.3% of surgical patients had documented penicillin allergy (n = 2296). At baseline, 22% of these patients received a cephalosporin, with an increase to more than 80% after algorithm implementation (P < .0001). Among 551 patients with penicillin allergy label who received a cephalosporin after algorithm implementation, no immediate allergic reactions requiring epinephrine were identified; 1 patient had a delayed rash that did not require cephalosporin discontinuation. Three patients received diphenhydramine for "itching" without rash in the setting of concomitant narcotic administration.ConclusionsUsing a streamlined algorithm, we were able to significantly reduce the use of second-line antibiotics in penicillin-allergic surgical patients without severe adverse reactions.Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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