Antibiotic allergy de-labelling in the perioperative setting

Background: Patients labelled as “allergic” to penicillin and cephalosporin antibiotics often receive alternative therapies for surgical antimicrobial prophylaxis. These treatments are less effective and associated with poor outcomes. Aims: The major aims of this thesis are to: 1. Assess the degree to which antibiotic allergy labels to penicillin and cephalosporin antibiotics influence rates of administering first-line antibiotics according to national guidelines 2. Implement a sustainable allergy assessment and de-labelling process within the perioperative clinic 3. Measure the impact de-labelling participants has on the adherence to recommended first-line antimicrobial prophylaxis for surgery. Secondary aims were to: 1. Determine the safety of allergy testing by non-allergy specialists 2. Determine the feasibility and efficiency of this approach; in respect to time spent in the perioperative clinic. Methods: The first study (PAPER 1) primarily focussed on measuring the degree by which antibiotic allergy labels lead to sub-optimal antibiotic prescribing. The second study (PAPER 2) was a before and after quasi-experimental study. The primary objective was to compare rates of optimal antibiotic prescribing before and after the introduction of a perioperative antibiotic allergy de-labelling program. Results: To summarise the main findings of the two papers: 1. This research elucidated that approximately 20-25% of patients with antibiotic allergy labels to penicillin and cephalosporin antibiotics are receiving sub-optimal antibiotics for surgery. 2. The introduction of a perioperative penicillin and cephalosporin allergy de-labelling program was associated with an improvement in antibiotic prescribing for surgery by 8%. To summarise the secondary findings: 1. Allergy risk-stratification, testing and de-labelling can be performed safely by non-allergy specialists prior to surgery. 2. This practice appears feasible and does not adversely increase appointment duration for elective surgical patients. Conclusion: Allergy de-labelling in the perioperative setting provides a unique opportunity to improve antibiotic prescribing for surgery. Such an intervention corresponds with key recommendations from healthcare governing bodies to prescribe targeted therapy wherever possible.