Elsevier

Mayo Clinic Proceedings

Volume 75, Issue 9, September 2000, Pages 902-906
Mayo Clinic Proceedings

Original Article
Reduction of Vancomycin Use in Orthopedic Patients With a History of Antibiotic Allergy

https://doi.org/10.4065/75.9.902Get rights and content

Objective

To reduce prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surgery by using a targeted allergy consultation and penicillin allergy skin testing.

Patients and Methods

The participants in this practice improvement study were patients with a history of penicillin or cephalosporin allergy who were scheduled for elective orthopedic surgery and referred by orthopedic surgeons for allergy consultation and penicillin allergy skin testing between September 22, 1998, and April 15, 1999. The primary outcome measure was the percentage of participants who received prophylactic cefazolin during the study period compared with historical controls.

Results

Of the 60 study patients, 59 received a penicillin allergy skin test, 58 underwent orthopedic surgery, and 55 received antibiotic prophylaxis. Fifty-five patients had a history of allergy to penicillin, a cephalosporin, or both, and 5 had a history of nonspecific antibiotic allergy. Of the 59 patients, 55 (93%) had negative penicillin allergy skin test results. Fifty-four (90%) of the 60 patients were given clearance by the allergist to receive cefazolin. Of the 55 study patients who received antibiotic prophylaxis, 6 (11%) received vancomycin compared with 38 (30%) of 127 historical controls (P≤05). None of the study patients had an immediate reaction to cefazolin or to vancomycin.

Conclusion

Prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surgery can be reduced by a targeted allergy consultation and penicillin allergy skin testing.

Section snippets

Study Patients

The study participants were patients with a history of antibiotic allergy who were scheduled for orthopedic surgery. Patients with a history of cephalosporin allergy or other antibiotic allergy were included if they were referred for evaluation of antibiotic prophylaxis. All patients were scheduled for an orthopedic procedure, most for the day after allergy consultation.

This project was undertaken as a practice improvement initiative. The study was supported by a practice improvement grant from

Results

Sixty patients (29 men and 31 women) with a mean age of 62 years (range, 16–89 years) were referred and evaluated in the study period. Twelve orthopedic surgeons referred patients to the study, 2 of whom referred 28 (47%) of the patients. Fifty-three patients (88%) were evaluated on the same day they were referred, and 7 (12%) had appointments other than the day of referral. Of the 60 patients, 48 gave a history of penicillin allergy, 2 gave a history of cephalosporin allergy, 5 had a history

Discussion

This report demonstrates that penicillin allergy testing and allergy consultation can reduce vancomycin use in patients with a history of penicillin allergy. A similar study showed that penicillin allergy skin testing can modify antibiotic use in 95% of patients with a prior history of penicillin allergy.15 Our observation that 93% of patients with a history of penicillin allergy had negative penicillin test results is similar to other reports. 11, 12

Previous reports also have shown that

References (17)

There are more references available in the full text version of this article.

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