AT IDSOG<\/p>\n
PARK CITY, UTAH (FRONTLINE MEDICAL NEWS)<\/span> <\/span>\u2013 When attendees at the annual scientific meeting of the Infectious Diseases Society for Obstetrics and Gynecology were asked if their institutions test to confirm alleged penicillin allergies, the only hands that went up were from clinicians at Duke University.<\/p>\n That\u2019s a problem, according to Robert Heine, MD, a maternal-fetal medicine specialist at Duke, in Durham, N.C. \u201cWe, as a group, need to be doing [penicillin] allergy testing,\u201d he said.<\/p>\n It\u2019s become clear in recent years that patients who say they have a penicillin allergy often don\u2019t have one, or remember a mild reaction from childhood that doesn\u2019t preclude the use of beta-lactam antibiotics as adults. For decades, however, clinicians have taken those claims at face value, and duly noted them in charts and switched patients to non\u2013beta-lactam antibiotics that don\u2019t work as well.<\/p>\n That\u2019s what happened at Duke in 2014. A total of 81 women with documented penicillin allergies were put on gentamicin and clindamycin to protect against cesarean wound infections and 16% ended up with infections anyway. Among the 864 women who received cefazolin \u2013 the first-line cesarean prophylaxis choice at Duke \u2013 the infection rate was 7%. <\/p>\n \u201cBeta-lactam antibiotic prophylaxis reduced the risk of surgical site infections after cesareans by 60%,\u201d said Benjamin Harris, MD, the lead investigator and an ob.gyn. resident at Duke, who presented the findings at the meeting.<\/p>\n When the investigators took a closer look at the 81 women who reported penicillin allergies, most of them had rashes and other mild reactions noted in their charts.<\/p>\n Findings such as those led Dr. Heine to push for routine testing. \u201cI brought Duke into it kicking and screaming,\u201d he said. The biggest obstacle was concern over liability, specifically that pregnant women would go into anaphylaxis and deliver prematurely, he said.<\/p>\n After a lot of lobbying, Dr. Heine and his colleagues started routine penicillin allergy testing in March 2016. There hasn\u2019t been a single reaction among the 80-plus pregnant women tested so far, he reported. <\/p>\n Duke administrators were also concerned about reimbursement, but it hasn\u2019t turned out to be a problem. Reimbursements from public and private payers \u201ccover our costs,\u201d a little over $100 per test, Dr. Heine said.<\/p>\n Dr. Heine said he can imagine outpatient testing at some point, but for now women are checked into triage. They get a fetal heart tone before 24 weeks, and a fetal heart rate monitor afterward. \u201cWe try to do it before 20 weeks so we don\u2019t have to worry about the fetus,\u201d he said. <\/p>\n When penicillin allergies are in the chart, or women say they are allergic, ask what type of reaction they had in the past. Type 1 reactions should be confirmed with testing. It\u2019s okay to skip testing and give beta-lactams for non\u2013type 1 reactions, but \u201cif a woman has a non\u2013type 1, and they\u2019re already set up for testing, I\u2019m going to do it anyway because getting the penicillin allergy off her chart is good for her and her life,\u201d Dr. Heine said.<\/p>\n Dr. Heine and Dr. Harris reported having no financial disclosures.<\/p>\n