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Editorial Commentary: Fortune Favors the Bold: Give a Beta-Lactam!

  1. Erica S. Shenoy2,4,5,6
  1. 1Division of Rheumatology, Allergy, and Immunology
  2. 2Medical Practice Evaluation Center, Department of Medicine
  3. 3Edward P. Lawrence Center for Quality and Safety
  4. 4Division of Infectious Disease, Department of Medicine
  5. 5Infection Control Unit, Massachusetts General Hospital
  6. 6Harvard Medical School, Boston, Massachusetts
  1. Correspondence: K. G. Blumenthal, Massachusetts General Hospital, 50 Staniford St, 9th Flr, Boston, MA 02114 (kblumenthal1{at}partners.org).

Key words

(See the Major Article by MacFadden on pages 904–10.)

Drug allergy is reported by 20%–40% of patients in the United States [1, 2]. Beta-lactam antibiotics, which include penicillins, cephalosporins, and carbapenems, are the most commonly implicated [1, 2]. Penicillin allergy prevalence estimates range from 8% to 25% across ambulatory and hospitalized populations [26]. With another 2% of patients reporting allergy to cephalosporin antibiotics, reported beta-lactam allergy impacts a substantial portion of our patients [79].

Patients who report a history of penicillin allergy may be treated with alternative antibiotics, including vancomycin, clindamycin, aztreonam, and fluoroquinolones, when they present with infections [3, 4, 10]. Some of these alternative antibiotics are used in patients reporting allergy histories despite a beta-lactam being the preferred antimicrobial agent [10]. Alternative agents may be less effective for specific infections, which can lead to higher rates of treatment failure [6, 10, 11]. Alternative agents expose patients to increased risk of toxicity, resulting in higher rates of drug discontinuation and adverse drug reactions [11, 12]. Use of alternatives to beta-lactams may additionally increase patients' risk of infection with resistant organisms, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci, and may increase the risk of Clostridium difficile colitis [4].

The vast majority, close to 95%, of patients who report an allergy to beta-lactam antibiotics are not truly allergic [7, 8, 13]. The …

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