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Are you really allergic to penicillin?

Published: December 14, 2017
Carmen L. Isache, M.D.
Yvette S. McCarter, Ph.D.

The antimicrobial stewardship program improves patient quality through individualized care.

When a patient is admitted to the hospital for a scheduled procedure or an emergency, they are asked a few key health questions. One of the most important is if they are allergic to penicillin. Until recently, a patient was taken at their word. If antibiotics are needed, they receive a prescription from a different drug family, even if it is not as effective, to avoid any type of allergic reaction.

UF Health Jacksonville’s antimicrobial stewardship program has changed how these situations are handled. Now when a patient is prescribed an antibiotic commonly used for someone with penicillin allergies, an alert is sent to the pharmacy and an investigation begins. Christopher Jankowski, PharmD, is a clinical pharmacist with advanced training in infectious diseases. He meets with a patient to learn more about their allergy and the type of reactions he or she experience. Family members who are present can also answer questions. Jankowski even calls the patient’s pharmacy or last known hospital where they were treated to find out which antibiotics the patient was prescribed.

“It’s a comprehensive approach,” Jankowski said. “Based on the interview and the information we’ve gathered, we’ll determine whether they are a low or high risk for an adverse penicillin reaction.” If the interview and research reveal the patient does not have an allergy, they can often be treated more effectively with a penicillin-based antibiotic.

“Nearly half of those interviewed are able to move to a penicillin-related drug with a low risk of an allergic reaction,” said Carmen Isache, MD.

Although only a basic program is required by the Centers for Disease Control and Prevention, UF Health Jacksonville has exceeded these standards, making an impact on a larger scale. So far, this program has saved UF Health Jacksonville around $1.7 million in drug expenditures.

The program also ensures patients are prescribed the right type and dose of antibiotics, and only when it is absolutely necessary — reducing the risk for the development of antibiotic-resistant bacteria.

“There is an increase in mortality for every hour someone does not get the right antibiotic when they have a positive blood culture,” said Yvette McCarter, PhD, director of the clinical microbiology laboratory.

McCarter works alongside Jankowski and Isache to ensure the tools and technology needed are available to keep the program running efficiently — improving outcomes and even saving lives. When rapid diagnostic technology is used, treatment can begin sooner and the risk of mortality decreases.

The program looks at all antibiotic use, not just penicillin allergy cases. Jankowski or a member of the pharmacy team reviews the patient’s blood cultures as they are updated in the system and contacts the prescribing physician to make any needed alterations to the drug therapy.

“We don’t want patients to stay in the hospital longer if they don’t need to be here,” Jankowski said. “We want to treat everyone appropriately, so they can get back to their lives.”

Carmen L. Isache, M.D.
Yvette S. McCarter, Ph.D.

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