Strategies for Improving the Management of Antibiotic Allergies

Elizabeth Phillips, MD, FRCPC, FRACP, Professor of Medicine, Pharmacology, and Pathology, Vanderbilt University Medical Center, explains different strategies for improving antibiotic allergy management.

Interview Transcript (slightly modified for readability)

“Antibiotic allergy management is something that, in general, infectious disease physicians, internists, physicians, and pharmacists, probably don’t get enough education [on]. So, education would be one of the key pillars that needs to be improved here, and education alone would probably have a huge impact in terms of improving antibiotic allergy management, and hence, antibiotic appropriateness. But, what is not known at this point is what the ideal combination of strategies would be.

One of the hurdles, and we did a survey about a year ago of infectious disease physicians and allergists, is not all practicing physicians and pharmacists have access to these testing procedures, or have access to subspecialty testing procedures. So, a very important question is: Can we use decision support, for instance, decision support built into the electronic health record, to help facilitate strategies to manage patients with antibiotic allergy and penicillin allergy that would then improve outcomes? And there is data from a couple of recent studies that have been done to look at this, one of which looked at a response of skin testing service, and the other of which looked at different mechanisms, including decision support, sequentially with antibiotic allergy testing with penicillin allergy testing.

I think the ‘take home’ from that, is that using decision support, even without going for the need for a subspecialty service to do testing, has a significant benefit in terms of improving antibiotic appropriateness. And, when I say ‘antibiotic appropriateness,’ that generally means less use of broader-spectrum antibiotics that are not the first-line for that indication, and more use of narrower-spectrum beta-lactam antibiotics.”