73 - Improving Cephalosporin Utilization in the Emergency Department for Penicillin Allergic Patients

Background: Penicillin (PCN) allergies impact acute-care antibiotic prescribing practices, limit the use of first-line antibiotic agents and are associated with poor patient outcomes. Cephalosporins (CPN) are inconsistently prescribed to patients reporting PCN allergies despite reported low allergy cross-reactivity.  The purpose of this study is to assess the impact of an education intervention on prescribing practices for CPN use in PCN allergic patients in the emergency department (ED).

Methods: This is a retrospective study evaluating all PCN allergic patients receiving a CPN in the ED from 07/01/2018 to 07/31/2019. The education intervention (consisting of circulating a locally developed guideline directing ED physicians to optimal CPN use given a designated PCN allergy along with lectures on suitable use of the guideline in recurring in-person sessions) occurred during 01/2019. We compared patient characteristics, CPN use, PCN allergy notation and adverse reactions between the “pre” (07/01/2018 – 12/31/2018) and “post” (02/01/2019 – 07/31/2019) groups.Antibiotic Allergy Cross Reactivity/Sensitivity Chart


Results: A total of 123 patients are included (53 “pre” vs.  70 “post”). Patient characteristics are similar (Table 1).  31 (12.1% vs. 13%, P = 0.5) received previous treatment with CPN with the most common choices being cefazolin (14, 11.3%), ceftriaxone (18, 14.6%) and cefepime (9, 7.3%).  14 (11.3%) received pretreatment prior to CPN use.  CPN given to patients in the ED include cefazolin (6 vs. 7), cephalexin (4 vs. 3), ceftriaxone (32 vs. 45) and cefepime (11 vs. 11). Common indications for CPN use include “empiric therapy” (38, 30.8%), “UTI” (17, 13.8%) and “pelvic region infection” (15, 12.1%). CPN administration routes include oral (10, 8.1%), intravenous (91, 73.9%) and intramuscular (22, 17.8%).  80 patients (65%) received a single dose of a CPN (37 vs. 43).  No significant difference is noted in CPN use between groups (P = 0.1).  Increased PCN allergy notation on tolerance to CPN after CPN use is noted, but later use of CPN use did not increase after notation (Table 2). No adverse events occurred from any CPN use.Table 1: Patient Characteristics
Table 2: PCN Allergy Notation Details


Conclusion: Education interventions on CPN use in PCN allergic patients require support with other strategies and tools. This intervention provides groundwork to initiate efforts to further improve CPN use in PCN allergic patients.