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Cephalosporin use in penicillin-allergic patients: a survey of otolaryngologists and literature review.
Laryngoscope 2015; 125(8):1822-6L

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

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.

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 -