Background: Penicillin discovered in 1928 by Sir Alexander Fleming, beginning of the antibiotic revolution. Penicillin as helped increase average life Span in USA from 47 years to 78.8 years. Beta lactam account to about 40% of total antibiotic use every year. 10% of patients in U.S. report penicillin allergy, but 9 out of 10 patients reporting penicillin allergy are not truly allergic when assessed by skin testing. 80% of skin test positive patients lose sensitivity by 10 years.

Purpose: False reporting of penicillin allergy leads to Broad spectrum antibiotics use and Increased antibiotic resistance, cost, hospital length of stay and toxicity. In the U.S. alone, antibiotic resistant bacteria cause at least 2 million infections and 23,000 deaths a year resulting in a $55–70 billion per year economic impact.Having a penicillin allergy causes 70% increased risk of new MRSAHaving a penicillin allergy causes 29% increased C difficile risk.Having a penicillin allergy causes 30% increased risk of VRE.MSSA Bacteremia : Duke University study showed, patients with MSSA bacteremia had 7% mortality with B lactams and 22% with Vancomycin.Why is there a significant (90%) false reporting of allergy ? 1. Side Effect is NOT an Allergy : Patients report nausea, antibiotic induced diarrhea as allergy. 2. Augmentin is also a Penicillin !! : Patients take other penicillin antibiotics but are unaware3. Lack of medical knowledge and poor literacy in rural Appalachian region : “ My mom had it, I think so do I” “My arm was hurting, little swollen after a IM Penicillin shot”

Description: What’s best way to know if its real ? Take a good history, review old charts (digging into all previous antibiotic use) and calling pharmacy for other outpatient antibiotic use. Educate patiet and document to stay on charts forever.STANDARD WORK :Identify all patients with penicillin or cephalosporin allergyProviders, pharmacist, residents, to review prior drug administration history and interview patient using the penicillin allergy questionnaireResults and recommendation from interviewee provided to the attending hospitalistPlace completed allergy questionnaire on patient chart and scan to pharmacyAttending hospitalist to enter a pharmacy communication order in SOARIAN / EPICInactivate Penicillin Allergy (tolerates penicillin) Update Penicillin Allergy (tolerates cephalosporin)May chose to test with oral 250mg Amoxicillin challenge or Pre pen testing. The patient will be given an allergy information card.Initially Piloted at Johnston Memorial Hospital and hospitist leadership expanded to 21 hospitals of Ballad Health:

Conclusions: Starting June 2018 to October 2019 in 21 Hospitals total of “1604 Patients – Penicillin / Beta Lactam Allergy Removed” Total Savings of $ 1, 443, 551 from removing allergies”Zero” adverse reactions from changing to Beta Lactam antibiotics. Days of Therapy (DOT) / 1000 patient days   FY17 to  FY 19  % Reduction at JMHAztreonam – from 8.5  to 1.7  – 80% reductionLevofloxacin 38.9 to 21.6  – 44.5% reductionMeropenem 49.2  to 28.8  – 41.5% reductionVancomycin 105 to 80.4  – 23.4% reductionHospital Acquired C Diff decreased 46% in 21 hospitals of Ballad Health and 89% at JMH, Abingdon ** Above three results were possible through other additional initiatives.This project not only has improved outcomes while in hospital but will have long lasting benefits for patients rest of life. Cost savings will only multiply for the number of years patient lives and will help with reducing resistant organisms for the entire community.

IMAGE 1:

IMAGE 2: