哮喘联盟

   摘要
   背景：自我报告的青霉素过敏偶尔反映青霉素不耐受。青霉素过敏的住院患者会得到可能更广谱、毒性更大或不太有效的替代抗生素治疗。
   目的：制定和评估一项临床指南，以用于指导医疗人员采集病史和为青霉素或头孢菌素过敏的患者开抗生素处方。
   方法：这项指南的实施是为了帮助医疗人员评估自报青霉素或头孢菌素过敏患者的过敏史以及为他们开抗生素处方。该指南采用了标准的2步分级激发或试验剂量。通过比较指南实施前21个月与指南实施后12个月的治疗，进行准实验研究以评估其安全性，可行性，以及对抗生素使用的影响。
   结果：与指南实施前比较，指南实施后每月β-内酰胺类抗生素试验剂量显著增加（中位数14.5，四分位数间距13-16.25, vs 中位数2，四分位数间距1-3.25, P <0.001）。在指南实施后的试验剂量下发生了7种药物不良反应，但指南实施前后不良反应的发生率（3.9％ vs 6.1％，P = 0.44）或严重程度（P>0.5）无显著差异。指南实施后的试验剂量减少了替代抗生素治疗，包括万古霉素（68.3％ vs 37.2％, P <0.001）、氨曲南（11.5％ vs 0.5％, P <0.001）、氨基糖苷类（6.0％ vs 1.1％, P = 0.004）和氟喹诺酮类（15.3％ vs 3.3％，P <0.001）。
   结论：对青霉素或头孢菌素过敏患者实施住院患者抗生素处方指南后，β内酰胺类试验剂量增加了近7倍，而药物不良反应没有增加。运用指南提供的试验剂量进行评估的患者，显著降低了替代抗生素的暴露。
 

（杨冬 审校）
Ann Allergy Asthma Immunol. 2015 Jun 9. pii: S1081-1206(15)00336-1. doi: 10.1016/j.anai.2015.05.011. [Epub ahead of print]


 

Impact of a clinical guideline for prescribing antibiotics to inpatients reporting penicillin or cephalosporin allergy.
 

Blumenthal KG1, Shenoy ES2, Varughese CA3, Hurwitz S4, Hooper DC5, Banerji A6.
 

Abstract
BACKGROUND:Self-reported penicillin allergy infrequently reflects an inability to tolerate penicillins. Inpatients reporting penicillin allergy receive alternative antibiotics that might be broader spectrum, more toxic, or less effective.
OBJECTIVE:To develop and assess a clinical guideline for the general inpatient provider that directs taking a history and prescribing antibiotics for patients with penicillin or cephalosporin allergy.
METHODS:A guideline was implemented to assist providers with assessing allergy history and prescribing antibiotics for patients with reported penicillin or cephalosporin allergy. The guideline used a standard 2-step graded challenge or test dose. A quasi-experimental study was performed to assess safety, feasibility, and impact on antibiotic use by comparing treatment 21 months before guideline implementation with 12 months after guideline implementation.
RESULTS:Significantly more test doses to β-lactam antibiotics were performed monthly after vs before guideline implementation (median 14.5, interquartile range 13-16.25, vs 2, interquartile range 1-3.25, P < .001). Seven adverse drug reactions occurred during guideline-driven test doses, with no significant difference in rate (3.9% vs 6.1%, P = .44) or severity (P > .5) between periods. Guideline-driven test doses decreased alternative antimicrobial therapy after the test dose, including vancomycin (68.3% vs 37.2%, P < .001), aztreonam (11.5% vs 0.5%, P < .001), aminoglycosides (6.0% vs 1.1%, P = .004), and fluoro quinolones (15.3% vs 3.3%, P < .001).
CONCLUSION:The implementation of an inpatient antibiotic prescribing guideline for patients with penicillin or cephalosporin allergy was associated with an almost 7-fold increase in the number of test doses to β-lactams without increased adverse drug reactions. Patients assessed with guideline-driven test doses were observed to have significantly decreased alternative antibiotic exposure.
 

AnnAllergy Asthma Immunol. 2015Jun9.pii:S1081-1206(15)00336-1.doi:10.1016/j.anai.2015.05.011. [Epub ahead of print]