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Update GP records on penicillin allergies to reduce superbug infections, says study

GP records should be updated to identify patients with true penicillin allergies to reduce the incidence of antibiotic-resistant superbug infections, a study has suggested.

Patients with a penicillin allergy listed in their notes were more likely to catch infections such as MRSA and C. difficile, the researchers found, but some 95% of these patients did not actually have an allergy.

The study was carried out by researchers at Massachusetts General Hospital in Boston, US, and looked at UK primary care records for just over 301,000 patients. Just under a third had a documented penicillin allergy and the remaining two-thirds were matched controls without penicillin allergy.

They found that that when figures were adjusted for risk factors such as number of hospital admissions, patients with penicillin allergy were at a 69% increased risk of catching MRSA and 26% increased risk of catching C. difficile.

The researchers also found that over an average follow-up period of six years, patients with documented penicillin allergy were more likely to be prescribed broad spectrum antibiotics than those without allergy. Greater use of these antibiotics accounted for 55% of the increased risk for MRSA and 35% of the increased risk for C. difficile.

The authors suggested that identifying true penicillin allergy could be an important public health strategy for reducing rates of superbug infection.

They said in the paper: ‘Most patients with a documented penicillin allergy are not allergic—that is, there is no immediate hypersensitivity. After evaluation by an allergist, about 95% of patients with reported penicillin allergies were found to be penicillin tolerant.

‘As infections with resistant organisms increase, systematic efforts to confirm or rule out the presence of true penicillin allergy may be an important public health strategy to reduce the incidence of MRSA and C difficile.’

BMJ 2018; available online 27th June

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