Maybe you’re not allergic

New penicillin testing protocol improves antibiotic options

A team of undergraduates mentored by associate professor of pharmacy Brandon Bookstaver have developed a new protocol being used at Palmetto Health Richland Hospital to determine if hospitalized patients who report having a penicillin allergy, in fact, are allergic.

“If you report a penicillin allergy, that eliminates the opportunity to use any related antibiotics, which then takes you, maybe, to the second tier of antibiotics, or the more toxic, or the more costly,” says Bookstaver. “Testing doesn’t just only open the door for penicillin but for all of the related antibiotics. That gives us a lot better options.”

Under the protocol, an infectious disease pharmacist will evaluate hospitalized patients who have reported a penicillin allergy to determine if they are candidates for penicillin allergy skin testing. After consulting with the rest of the antimicrobial stewardship team, which includes the patient’s physician, the infectious disease pharmacist will then administer the test, which takes 45 minutes to one hour.

“In over 95 percent of patients, their history of an allergy is actually incorrect,” says Bookstaver. “These patients test negative at least to major allergic reactions. There may be some minor reactions that the test doesn’t look for, but these would be more of a nuisance as opposed to a more serious negative outcome like anaphylaxis.”

The protocol is pharmacist-driven for two reasons, accord­ing to Bookstaver, who also serves as director of residency and fel­low­ship training at the College of Pharmacy.

“One, they have the knowledge of antibiotics and the ability to reconcile antibiotic allergies,” he says. “Two, you only have to train a couple of pharmacists to be able to cover an entire hospital. If you were to train physicians or nurses, you would have to train a lot more of them.”

At present, three pharmacists have been trained in the new protocol and are currently implementing it at Palmetto Health Richland. Two pharmacy residents in the infectious disease residency program will also be trained, along with two recently hired infectious disease pharmacists at the College of Pharmacy. One of those pharmacists works jointly with the Department of Health and Environmental Control; the other works at Palmetto Health Park Ridge Hospital in Irmo, S.C.

Because the student team, led by third-year pharmacy student Nicki Griffith, has shepherded the project through the approval process at the S.C. Board of Pharmacy, the S.C. Board of Nursing and the S.C. Board of Medical Examiners, pharmacists at any other hospital in the state can now admin­ister the protocol in the hospital setting.

Meanwhile, patients are getting a small dose of training themselves.

“We’re trying to make sure that the patient is well educated, so they can tell their pharmacist and their physician’s office that they no longer have a serious penicillin allergy and that they can remove that from their profile,” says Bookstaver. “Our goal is not only to affect a patient’s antibiotic use in one hospitalization but to affect their antibiotic use long term.”

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