Reviewed by Barry Rittmann, MD, MPH, Virginia Commonwealth University
Antibiotic allergy labels (AALs) have significant effects on infectious disease management and outcomes. AALs have been associated with a nearly 50% increased risk of inappropriate antibiotic prescribing, and have negative impact on antimicrobial stewardship, increased rates of HAIs, including Clostridioides difficile, MRSA, and VRE infections, surgical site infections, and worse outcomes for patients. It is estimated that 16.8% of ICU patients have at least one AAL. In the November edition of Clinical Infectious Diseases, Mitri et al. provided an excellent review of potential approaches to delabeling patient with false AALs, by identifying low to high-risk phenotypes, leading to either direct delabeling, direct oral challenge (DOC), or intradermal testing/skin prick testing. Given the limited access to an allergy/immunology specialist, special consideration was given to identify non-allergist-led assessment and management in non-high-risk phenotypes. This article provides insight and clarity for any group looking to develop an intervention to reduce the rates of AALs in their hospital system.
Reference:
Elise A Mitri, Gemma K Reynolds, Ana Maria Copaescu, Fionnuala Cox, Jamie L Waldron, Jonny G Peter, Jason A Trubiano, State-of-the-Art Review: Antibiotic Allergy—A Multidisciplinary Approach to Delabeling, Clinical Infectious Diseases, Volume 81, Issue 4, 15 October 2025, Pages e74–e92, https://doi.org/10.1093/cid/ciaf401