Association of Penicillin or Cephalosporin Allergy Documentation and Antibiotic Use in Hospitalized Patients with Pneumonia

ABSTRACT Background Treatment guidelines for pneumonia recommend beta-lactam antibiotic-based therapy. Although reported penicillin allergy is common, more than 90% of patients with reported penicillin allergy are not allergic. Objective We evaluated the association of a documented penicillin and/or cephalosporin (P/C) allergy to antibiotic use for the treatment of inpatient pneumonia. Methods This was a national cross-sectional study conducted among Vizient, Inc. network hospitals that voluntarily contributed data. Among hospitalized patients with pneumonia, we examined the relation of a documented P/C allergy in the electronic health record to prevalence of first-line beta-lactam antibiotic administration and alternative antibiotics using multivariable log-binomial regression with Generalized Estimating Equations. Results Of 2,276 inpatients receiving antibiotics for pneumonia at 95 US hospitals, 450 (20%) had a documented P/C allergy. Compared to pneumonia patients without a documented P/C allergy, patients with a documented P/C allergy had reduced prevalence of first-line beta-lactam antibiotic use (adjusted prevalence ratios [aPR] 0.79 [95%CI 0.69, 0.89]). Patients with high-risk P/C reactions (n=91) had even lower prevalence of first-line beta-lactam antibiotic use (aPR 0.47 [95% CI 0.35, 0.64]). Alternative antibiotics associated with a higher use in pneumonia patients with a documented P/C allergy included carbapenems (aPR 1.61 [95%CI 1.22, 2.13]) and fluoroquinolones (aPR 1.52 [95%CI 1.21, 1.91]). Conclusions Inpatients with documented P/C allergy and pneumonia were less likely to receive recommended beta-lactams and more likely to receive carbapenems and fluoroquinolones. Inpatient allergy assessment may improve optimal antibiotic therapy for the 20% of inpatients with pneumonia and a documented P/C allergy.