Enabling Antibiotic Allergy Evaluations and Reintroduction of First-Line Antibiotics for Cystic Fibrosis Patients.

Abstract

BACKGROUND\nCystic fibrosis (CF) patients often have a history of antibiotic adverse drug reactions (ADRs) that pose a barrier to receiving recommended first-line treatment. Targeted antibiotic allergy evaluations are increasingly recognized as an important strategy for optimization of antimicrobial stewardship.\n\n\nOBJECTIVE\nTo improve first-line antibiotic use in CF patients with antibiotic ADRs by streamlining access to antibiotic allergy evaluations and standardizing documentation of plans for antibiotic reintroduction.\n\n\nMETHODS\nWe incorporated allergy evaluations into a multidisciplinary CF clinic and utilized telemedicine when allergy evaluations could not be performed during CF clinic. Standard documentation of antibiotic allergy plans was utilized to enable safe reintroduction of first-line antibiotics by CF providers.\n\n\nRESULTS\nStrategies utilized in this study allowed 81.3% (26/32) of CF patients to receive allergy evaluations and antibiotic allergy plans for prioritized antibiotics (penicillin, cephalosporin, sulfonamide), with removal of 41.0% (16/39) of prioritized antibiotic ADRs. Only 5.1% (2/39) of prioritized antibiotic ADRs evaluated required strict avoidance after evaluation. Nine patients received at least one prioritized antibiotic, with 66.6% (6/9) of these patients given the antibiotic after only one allergy evaluation visit. Additionally, these strategies allowed allergy evaluations of 23 non-prioritized antibiotics to occur, with removal of the ADR in 39.1% (9/23) and use of 77.8% (7/9) of non-prioritized antibiotics after removal.\n\n\nCONCLUSION\nIncorporating allergy evaluations into a multidisciplinary CF clinic can liberalize first-line antibiotic use in CF patients. Standard documentation of antibiotic allergy plans allowed antibiotic reintroduction to occur even prior to complete removal of documented antibiotic ADRs.