Discussing the Legal Liability of Prescribing Beta-Lactams to Penicillin-Allergic Patients

Meghan Jeffres, PharmD, assistant professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, discusses the legal liability of prescribing beta-lactams to patients who are allergic to penicillin.

Interview Transcript (slightly modified for readability):

“One of the potential reasons why physicians and prescribers are reluctant to use beta-lactams in a patient with a penicillin allergy is the fear that, ‘If I give a beta-lactam to a patient that has a known penicillin allergy, and they have a reaction, then I am medically liable, and that I could be successfully sued if there is a bad outcome in this patient.’

In a review of the case literature, we found that there were 27 cases since 1959 looking at this exact scenario; the patient had a known penicillin allergy, received another beta-lactam, and had an adverse reaction to it. That is not a ton of cases when you think [of the fact that they go] back to 1959. However, it is worth noting that in the past decade—from 2005 to 2015—the highest number of cases that fit this parameter were reported (7 cases). Still not a ton of cases, however, consistently, what has been shown in the case precedents in these areas—even in the setting with a known penicillin allergy, receipt of prescribing of a beta-lactam, and experience of an adverse reaction, including and up to death—prescribers are not liable if it is a cephalosporin or a carbapenem. In fact, expert witnesses and judges have identified that there is no contraindication in the receipt of these (medications).

There has been nothing said in case law so far that talks about side chain similarities and dissimilarities. It will be interesting to see if that plays a role in medical liability.

In terms of using a cephalosporin or using a carbapenem in patients that have a known penicillin allergy, there is good legal precedents that say [the prescriber] is not going to be liable in a bad outcome.

In terms of using a penicillin in patients that have a penicillin allergy, about 50% go in favor of the defendant versus the provider. And so, in that situation, it is most likely associated with poor decision making where the provider is using penicillin because [perhaps] they forgot, or it slipped through the cracks of the medication ordering process. Even in those situations, if there was a known medical need, for instance if the patient had neurosyphilis and [the provider] really needed to use penicillin, and the patient had an adverse reaction, as long as [the provider] documented the idea that this was a medical need and there was a risk-benefit analysis that was performed, and [the provider] still chose to give penicillin, I think in those situations, based on the precedents that have been published so far, [the provider] would still be successful in court.”