Abstract
Rationale
Antibiotic allergy labels (AAL) to first-line antibiotics such as penicillin, cephalosporins, and trimethoprim-sulfamethoxazole, lead to the use of alternative antibiotics with inferior outcomes. For low-risk penicillin (PAL), cephalosporin (CAL), and trimethoprim-sulfamethoxazole allergy (SAL) labels, direct oral challenge (DOC) without skin testing is now standard but associated with the burden of multiple repeat visits. We aimed to improve patient convenience, adherence and delabeling efficacy through Multiple Antibiotic Allergy Evaluation Strategy (MAAES-DOC).
Methods
We evaluated the safety and efficacy of MAAES-DOC, defined as two or more first-line DOC in a single visit. From January 2020-April 2024, 421 adult patients with at least two of PAL, CAL or SAL underwent risk assessment to identify low-risk patients. DOCs were done in low-risk patients after shared decision-making with tolerance confirmed post-observation period and nursing follow-up.
Results
Of 421 patients, 103 (24.5%) qualified for MAAES-DOC (median age 58 [IQR 39–72]); 82.5% female). A total of 214 AALs underwent DOCs: 85 (39.7%) PAL, 54 (25.2%) CAL, and 75 (35%) SAL. Delabeling succeeded in 102/103 (99%); 95 (92.2%) completed in a single visit, and 7 in two, with a median of 2 labels removed per patient. In combination groups, 27/28 (96.4%) had PAL+CAL delabeled, 48/49 (97.9%) PAL+SAL, 16/18 (88.9%) CAL+ SAL, and 8/8 (100%) had all three removed.
Conclusions
MAAES-DOC is a safe and effective “real-world” approach for delabeling multiple low-risk antibiotic allergies through multiple DOC in a single visit. This strategy streamlines care by safely and efficaciously removing first-line AAL, reducing clinic visits while maintaining high success and patient adherence.