Penicillin Allergy De‐Labeling in Older Adults and Long‐Term Care Residents: A Clinical Review.
Background: Penicillin allergy labels are common in older adults and long‐term care (LTC) residents, contributing to inappropriate antibiotic use, adverse outcomes, and increased healthcare costs. This review examines the prevalence, impact, safety, and barriers to penicillin allergy evaluation and...
| Publicado en: | Journal of the American Geriatrics Society Vol. 73; no. 10; pp. 3234 - 3245 |
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| Autores principales: | , , , , , |
| Formato: | Artículo |
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Wiley-Blackwell
Oct2025
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=188899866&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 188899866 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Oct2025 vid: 73 iid: 10 pid: 480 pub: Wiley-Blackwell artinfo: ui: 188899866 10.1111/jgs.19619 ppf: 3234 ppct: 11 formats: tig: atl: Penicillin Allergy De‐Labeling in Older Adults and Long‐Term Care Residents: A Clinical Review. aug: au: Shah, Ruchi J. Smith, Liam R. Norton, Dylan T. Eippert, Madelyn L. Borzecki, Ann M. Blumenthal, Kimberly G. affil: Division of Rheumatology Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston Massachusetts,, USA Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Massachusetts General Hospital, Boston Massachusetts,, USA Harvard Medical School, Boston Massachusetts,, USA Center for Health Optimization and Implementation Research (CHOIR), Bedford Campus, VA Bedford Healthcare System, Bedford Massachusetts,, USA Department of General Internal Medicine, Boston University School of Medicine, Boston Massachusetts,, USA School of Public Health, Department of Health Law, Policy and Management, Boston University School of Public Health, Boston University, Boston Massachusetts,, USA su: Patient safety Interprofessional relations Medical care costs Old age Drug allergy Antibiotics Geriatric nursing Cross infection Long-term health care Antimicrobial stewardship Drug resistance in microorganisms Immunology Oral drug administration Treatment effectiveness Penicillin Drug labeling Skin tests Drug utilization sug: subj: Patient safety Interprofessional relations Medical care costs Old age Medicinal and Botanical Manufacturing Pharmaceutical and medicine manufacturing Pharmaceuticals and pharmacy supplies merchant wholesalers Drugs and Druggists' Sundries Merchant Wholesalers Drug allergy Antibiotics Geriatric nursing Cross infection Long-term health care Antimicrobial stewardship Drug resistance in microorganisms Immunology Oral drug administration Treatment effectiveness Penicillin Drug labeling Skin tests Drug utilization keyword: antimicrobial stewardship beta‐lactam drug challenge hypersensitivity skin testing antimicrobial stewardship beta‐lactam drug challenge hypersensitivity skin testing ab: Background: Penicillin allergy labels are common in older adults and long‐term care (LTC) residents, contributing to inappropriate antibiotic use, adverse outcomes, and increased healthcare costs. This review examines the prevalence, impact, safety, and barriers to penicillin allergy evaluation and de‐labeling in these populations. Methods: This review synthesizes findings from studies on penicillin allergy prevalence, evaluation, and de‐labeling practices in older adults and LTC settings. Articles were identified using searches in PubMed, Embase, and Cochrane databases. Key data presented include de‐labeling prevalence, safety of testing strategies including direct oral challenges, and barriers to implementation. Results: Older adults and LTC residents exhibit higher penicillin allergy label prevalence than other populations, though true penicillin allergies are confirmed in a minority of tested individuals. Penicillin allergy labels result in reliance on second‐line antibiotics, which can be less effective and more broad‐spectrum, leading to increased multidrug‐resistant infections, healthcare‐associated infections, and higher healthcare costs. Penicillin allergy evaluation using risk stratification and procedures, including direct oral challenges, has been shown to be safe, with minimal adverse reactions in older adults. Many patients with low‐risk histories have been shown to be de‐labeled by history alone, reducing the need for specialized allergy evaluation and testing. Barriers to implementation of de‐labeling in older adults and LTC facilities include resource limitations, knowledge gaps, and safety concerns, whereas facilitators include multidisciplinary support, standardized protocols, and patient engagement. Conclusions: Penicillin allergy evaluation and de‐labeling of inaccurate penicillin allergies in older adults and LTC settings is both feasible and safe, offering substantial benefits for individual patient care and broadly for antibiotic stewardship. Addressing implementation barriers through standardized protocols, provider education, and multidisciplinary collaboration may improve adoption and outcomes. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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