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

• Research
• Open Access
• Allergy, Asthma & Clinical Immunology

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

Allergy, Asthma & Clinical Immunology volume 16, Article number: 6 (2020) 

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

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

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.

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