Antibiotic hypersensitivity and adverse reactions: management and implications in clinical practice

Anthony Jourdan, Brijit Sangha, Eric Kim, Sohrab Nawaz, Vikram Malik, Radhika Vij, Sudhir Sekhsaria, Anthony Jourdan, Brijit Sangha, Eric Kim, Sohrab Nawaz, Vikram Malik, Radhika Vij, Sudhir Sekhsaria

Abstract

Background: Studies have shown the discrepancy between self-reported antibiotic allergies and true allergies. Inaccurate reporting of antibiotic hypersensitivities can limit treatment options and result in use of more expensive antibiotics and contribute to resistance.

Methods: This retrospective cohort chart review obtained data on 16,515 patients after obtaining IRB approval. Patients who had an antibiotic adverse reaction were identified, recorded, and their management reviewed. 7926 patients were selected from inpatient internal medicine clinics, 8042 patients from outpatient internal medicine clinics, and 547 from orthopedic clinics.

Results: The prevalence of reported antibiotic sensitivity in our study was 9.89% (n = 1624). Reported antibiotic sensitivity was 8.88% (n = 704) in inpatient settings as compared to 11.2% (n = 902) and 5.12% (n = 28) in medicine and orthopedic outpatient settings respectively. The top five antibiotic adverse reactions reported were penicillins (42%), sulfonamides (25%), fluoroquinolones (4.3%), tetracyclines (4.2%), and macrolides (3.5%). In all settings, penicillins and sulfonamides adverse reactions were the top two reportings. 11.88% (n = 193) of patients with reported adverse reactions reported sensitivities to multiple antibiotics.

Conclusion: Our study demonstrated high prevalence of reported antibiotic sensitivity in three clinical settings. However, a significant portion of these patients may not be truly hypersensitive to these antibiotics. There is a need for increased awareness among medical professionals about the importance of detailed history taking and management of self-reported antibiotic allergies to combat unnecessary use of antibiotics.

Keywords: Adverse reactions; Allergy; Anaphylaxis; Antibiotic; Cutaneous reactions; Hypersensitivity; Penicillin.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Flow chart of collection of data. Study design showing the number of patients with documented antibiotic hypersensitivity and the demographics of the population in regards to age. After collecting and reviewing medical records, the patients were separated by the type of care facility they received care. Date of birth information was collected to provide demographic insight of the cohort. Antibiotic hypersensitivity was then identified in these patients and prevalence data was synthesized
Fig. 2
Fig. 2
Most common reported antibiotic hypersensitivities. Hypersensitivities to specific antibiotics are noted above. The reportings are separated by all three settings (total), inpatient internal medicine, outpatient internal medicine, and outpatient orthopedic. The legend located within the inset of the graphs states which bars correspond to which antibiotic class
Fig. 3
Fig. 3
a Types of reaction reported in all three clinical settings. Reported reactions from patients across all three settings are reported. The reactions were classified into anaphylaxis, cutaneous reactions, GI symptoms, and Not Reported/Not Applicable. Cutaneous reactions include itching, redness, hives, angioedema, red man syndrome, rashes, and swelling. Not reported/Not applicable includes documentations of unknown and N/A. b Types or reaction reported by clinical setting. Reported reactions from patients at each of the three clinical setting categories. Bars are coordinated to the associated bar design in Fig. 3a. No reportings of GI symptoms or anaphylaxis occurred at outpatient orthopedic clinics

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