‘Penicillin allergy’ raises MRSA risk

A UK health authority has asked health practitioners to be sceptical of claimed penicillin allergies

Patients who incorrectly believe they are allergic to penicillin may be placing themselves at unnecessary increased risk of developing MRSA or C difficile, warns the National Institute for Health and Care Excellence.

The Institute – NICE – says that health care staff need to be aware of this increased risk and ensure that only people with a “true” allergy to penicillin are documented as having the allergy.

The warning follows a Medicines Evidence Commentary regarding research conducted in the UK, which had been published in the BMJ in June 2018.

“A large population-based cohort study from UK general practice data found that people with a documented ‘penicillin allergy’ had an increased risk of meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile,” this commentary stated.

“This increased risk was thought to be brought about by the increased use of antibiotics selected as an alternative to beta-lactams.”

This risk of developing MRSA is nearly 70% higher for people with documented penicillin allergy, while the risk of developing C difficile is around 25% higher.

Around 10% of the general population claim to be allergic to penicillin, the commentary says, though this may be due to symptoms such as a skin rash during a course of penicillin in childhood.

Less than 10% of people who believe themselves to be allergic to penicillin actually have an allergy to the drug.

Incorrectly identifying people as allergic to penicillin could also contribute to antimicrobial resistance, as these people are more likely to be given broad-spectrum antibiotics, NICE warns.

“Lots of people think they are allergic to penicillin because it gave them a rash when they were a child, their mum or dad told them they were allergic and it has stayed in their notes for decades,” says NICE deputy chief executive Professor Gillian Leng.

“That is a very different thing to having a true penicillin allergy, which can result in a life-threatening anaphylactic reaction.

“If healthcare staff use NICE guidance to distinguish properly between the two, that could help stop the spread of both MRSA and antimicrobial resistance.”

Following the publication of the research, a physician and former pharmacist, Eugene Yeung, also wrote to the BMJ urging that pharmacists be utilised in identifying true penicillin allergy.

“If a patient’s main reason for visit is not penicillin allergy reaction, an allergy assessment may end up in the bottom of physicians’ priority lists,” he wrote.

“Being an ex-pharmacist myself, I know plenty of pharmacists who would love to be more involved in patients’ therapeutic management.

“Pharmacist involvement has been shown to improve allergy documentation. Many NHS primary care services are now providing pharmacist support for physicians and patients.

“I would like to suggest physicians to make good use of pharmacists to perform allergy assessments, which are important for patient safety.”

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