Elective penicillin skin testing and amoxicillin challenge: Effect on outpatient antibiotic use, cost, and clinical outcomes☆,☆☆,★,★★
Section snippets
Study design and patient selection
A natural history study on 255 patients who underwent PenSTs between November 16, 1994 and November 15, 1995 was performed. A subgroup of 237 patients (92.9%) who were health plan members during the full year before and after PenSTs and who obtained at least 1 prescription medication from a health plan pharmacy were identified. One outlier with a mycobacterium lung infection, who accounted for 4.2% of all antibiotic courses and 18.4% of antibiotic costs for the 2-year duration of the study, was
Demographics of the study subjects
The demographics of the 236 subjects in this study are displayed in Table I.The clinical histories of the study subjects, including the type of index adverse reaction, time to onset of adverse reaction after initiation of antibiotic therapy, and treatment of the index adverse reaction, are not significantly different from the whole population as reported previously.8
AC
The demographics of the 146 subjects who self selected AC are displayed in Table II and compared with those of subjects who refused AC.Empty Cell AC (n = 146) No AC (n = 50) P value Age (yrs) 37.4 ± 22.4 47.7 ± 21.0 .0072 Female 99 (67.8%) 34 (68.0%) NS Time since reaction (yrs) 15.58 ± 16.23 16.23 ± 16.55 NS Dispensed penicillin (yr before PenST) 27 (18.4%) 13 (26.0%) NS Dispensed penicillin (yr after PenST) 69 (47.3%) 24 (48.0%) NS Reported adverse reaction with AC or therapeutic course of penicillin (yr
DISCUSSION
Up to 10% of outpatients will report histories of PCA “allergy.”8, 9, 10 The specifics of the clinical history of the adverse reaction have been shown to be inadequate to safely determine true allergy as defined by the presence of specific IgE directed against penicillin determinants.8, 11 Thus physicians must avoid PCAs in any patient claiming penicillin allergy unless the allergy can be disproven. PenSTs have been previously shown to identify those individuals at highest risk for serious
Acknowledgements
I thank Denice D. Wei-Tsao, MS, for statistical assistance and outpatient care data acquisition; Girma Wolde-Tsadik, PhD, for statistical assistance; Randy Nakahiro, PharmD, for pharmacy record acquisition; Robert Zeiger, MD, PhD, for editorial assistance and general support; the Allergy Nurses for performing the PenSTs and ACs; and the Allergy Physicians of the SCPMG for enrolling patients.
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From Kaiser Permanente, San Diego Medical Center, Department of Allergy, UCSD School of Medicine, Department of Medicine, San Diego.
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Supported by Southern California Permanente Medical Group, Kaiser Permanente Southern California.
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Reprint requests: Eric Macy, MD, 7060 Clairemont Mesa Blvd, San Diego, CA 92111.
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