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Cephalosporin use in penicillin-allergic patients: a survey of otolaryngologists and literature review.

Abstract

OBJECTIVES/HYPOTHESIS

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.

STUDY DESIGN

Cross-sectional survey.

METHODS

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.

RESULTS

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 (P = .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.

CONCLUSIONS

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.

LEVEL OF EVIDENCE

NA

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.

    ,

    Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.

    ,

    Department of Population Health, New York University School of Medicine, New York, New York, U.S.A. Department of Environmental Medicine, New York University School of Medicine, New York, New York, U.S.A.

    ,

    Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.

    Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.

    Source

    The Laryngoscope 125:8 2015 Aug pg 1822-6

    MeSH

    Anti-Bacterial Agents
    Cephalosporins
    Drug Hypersensitivity
    Humans
    Otitis Media
    Otolaryngology
    Penicillins
    Surveys and Questionnaires

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    25752938

    Citation

    Persky, Michael J., et al. "Cephalosporin Use in Penicillin-allergic Patients: a Survey of Otolaryngologists and Literature Review." The Laryngoscope, vol. 125, no. 8, 2015, pp. 1822-6.
    Persky MJ, Roof SA, Fang Y, et al. Cephalosporin use in penicillin-allergic patients: a survey of otolaryngologists and literature review. Laryngoscope. 2015;125(8):1822-6.
    Persky, M. J., Roof, S. A., Fang, Y., Jethanamest, D., & April, M. M. (2015). Cephalosporin use in penicillin-allergic patients: a survey of otolaryngologists and literature review. The Laryngoscope, 125(8), pp. 1822-6. doi:10.1002/lary.25227.
    Persky MJ, et al. Cephalosporin Use in Penicillin-allergic Patients: a Survey of Otolaryngologists and Literature Review. Laryngoscope. 2015;125(8):1822-6. PubMed PMID: 25752938.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cephalosporin use in penicillin-allergic patients: a survey of otolaryngologists and literature review. AU - Persky,Michael J, AU - Roof,Scott A, AU - Fang,Yixin, AU - Jethanamest,Daniel, AU - April,Max M, Y1 - 2015/03/05/ PY - 2015/02/03/accepted PY - 2015/3/11/entrez PY - 2015/3/11/pubmed PY - 2015/10/7/medline KW - Allergy KW - antibiotic KW - clinical practice guidelines KW - evidence-based medicine KW - immunology KW - pen-allergic KW - penicillin SP - 1822 EP - 6 JF - The Laryngoscope JO - Laryngoscope VL - 125 IS - 8 N2 - OBJECTIVES/HYPOTHESIS: 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. STUDY DESIGN: Cross-sectional survey. METHODS: 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. RESULTS: 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 (P = .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. CONCLUSIONS: 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. LEVEL OF EVIDENCE: NA SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/25752938/full_citation L2 - https://doi.org/10.1002/lary.25227 DB - PRIME DP - Unbound Medicine ER -