Impact of reported penicillin allergy on kids

Reviewed by Zach Willis, MD, MPH, UNC School of Medicine

In this retrospective cohort study, Joerger, et al., used data from two large pediatric healthcare systems to assess the effect of penicillin allergy labels on antibiotic prescribing practices and outcomes in over 200,000 children with respiratory tract infections (otitis media, sinusitis, community acquired pneumonia, group A Strep pharyngitis). Children with a penicillin allergy label were significantly more likely to receive second-line antibiotics (RR 4.87) or broad-spectrum antibiotics (RR 3.24). They were also significantly more likely to suffer an adverse drug event (RR 1.28); there were no differences in the risk of treatment failure between the two groups. As amoxicillin and amoxicillin-clavulanate are the first-line antibiotics for the most common pediatric bacterial respiratory tract infections, it is not surprising that the vast majority of children with a reported penicillin allergy were much more likely to receive second-line and broad-spectrum antibiotics, such as cefdinir and azithromycin. However, this study establishes the magnitude of the problem and demonstrates the importance of avoiding inappropriate penicillin allergy labels and implementing penicillin allergy de-labeling for children. Removing inaccurate penicillin allergy labels in childhood may reduce the prevalence of reported penicillin allergy throughout the lifespan.

Joerger T, Taylor MG, Li Y, Palazzi DL, Gerber JS. Impact of Penicillin Allergy Labels on Children Treated for Outpatient Respiratory Infections. Journal of the Pediatric Infectious Diseases Society 2022; piac125.

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