Should You Incorporate Penicillin Skin Testing in Your Hospital?

Meghan Jeffres, PharmD, assistant professor in the Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy, shares what should be considered when considering the incorporation of penicillin skin testing into a health care facility.

Interview Transcript (slightly modified for readability):

“Penicillin skin testing has recently been incorporated in the inpatient setting in several large academic centers and even in some smaller community hospitals as well. The goal of penicillin skin testing is to increase beta-lactam use and subsequently decrease some cost in the hospital setting. [This decrease] has been associated with better antibiotic selection.

With this goal in mind, [penicillin skin testing] has been effective. If you can show that the patient is not going to have an anaphylactoid-like reaction to penicillin, prescribers then become more comfortable in using a beta-lactam. In that specific analysis, [penicillin skin testing is] effective at changing prescriber habits.

I would argue that is ultimately not necessary. The penicillin skin testing [will reveal] that 96% of the patients will be negative. When you have a test where 96% of the people will be negative, is that test truly necessary? Can we just go ahead and use the beta-lactam without having to use the penicillin skin test?

Can you educate into using beta-lactams in these patients, or do you need to have an objective test that eases the anxiety associated with it? I think that would be a very interesting comparison to add to the literature and something that is worth evaluating.

Another question that we do not really know yet about penicillin skin testing is when is it truly an intervention that would be economically beneficial? For instance, if you are in an institution that already uses beta-lactams in 90% of the patients that carry the penicillin allergy label, is introducing a penicillin skin testing service, which is quite an undertaking, and requires a lot of man-hours to operate, is it worth it for that extra 10%? Or, [perhaps you look at] an institution where 50% of the patients that are labeled as penicillin allergic are getting non-beta-lactams. [Is that] that tipping point [the percent] of poor prescribing for this patient population that is worth it for incorporating this service? [Or, should the institution] really focus more of an educational effort on what is the best and safest antibiotic for patients that are labeled as penicillin allergic?”