Cephalosporin use in penicillin‐allergic patients: A survey of otolaryngologists and literature review. (5th March 2015)

• Record Type: Journal Article
• Authors: Persky, Michael J.; Roof, Scott A.; Fang, Yixin; Jethanamest, Daniel; April, Max M.
• Is Part Of: Laryngoscope. Volume 125:Number 8(2015:Aug.)
• Page Start: 1822
• Page End: 1826
• Publication Date: 2015-03-05
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.25227
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary25227-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>This study investigated the differences between the standard guidelines and the practice patterns of otolaryngologists in managing "penicillin‐allergic" patients. A major goal was to identify factors influencing an otolaryngologist's choice of antibiotic.</p> </sec> <sec id="lary25227-sec-0002" sec-type="section"> <title>Study Design</title> <p>Cross‐sectional survey.</p> </sec> <sec id="lary25227-sec-0003" sec-type="section"> <title>Methods</title> <p>Four hundred seventy members of the American Society of Pediatric Otolaryngologists (ASPO) and 150 general otolaryngologists from the Florida Society of Otolaryngology (FSO) were surveyed.</p> </sec> <sec id="lary25227-sec-0004" sec-type="section"> <title>Results</title> <p>Ninety‐six ASPO members (20.4%) and 22 members of FSO (14.6%) responded. When asked about the management of a pediatric patient with acute otitis media and a history of a nonsevere immunoglobulin E (IgE)‐mediated amoxicillin allergy, 54% of ASPO respondents indicated they would initiate guideline‐recommended cefdinir, whereas only 27% of FSO respondents chose cefdinir (<italic>P</italic> = .02). Otolaryngologists who are fellowship trained in pediatrics or have pediatric‐focused practices were significantly more likely to prescribe cefdinir. Overall, 57% of respondents indicated that they were familiar with the literature regarding the cross‐reactivity of β‐lactams, but only 25% of respondents felt that they could easily differentiate a potentially life‐threatening IgE‐mediated allergy from a non–IgE‐mediated drug intolerance.</p> </sec> <sec id="lary25227-sec-0005" sec-type="section"> <title>Conclusions</title> <p>The data show differences between the current recommendations and the behavior of otolaryngologists. Pediatric otolaryngologists were more familiar with the guideline‐recommended therapy, likely from their frequent exposure to patients requiring a β‐lactam. Nevertheless, most otolaryngologists could benefit from increased awareness of the current literature. Patients may be receiving less than optimal medication management due to a misidentification of those at risk of life‐ threatening allergic cross‐reactions.</p> </sec> <sec id="lary25227-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>NA <italic>Laryngoscope</italic>, 125:1822–1826, 2015</p> </sec> </abstract>