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

• Published in: The Laryngoscope 2015-08, Vol.125 (8), p.1822-1826
• Main Authors: Persky, Michael J., Roof, Scott A., Fang, Yixin, Jethanamest, Daniel, April, Max M.
• Format: Article
• Language: English
• Subjects: Allergies; Allergy; Anti-Bacterial Agents - therapeutic use; antibiotic; Cephalosporins - therapeutic use; clinical practice guidelines; Drug Hypersensitivity; Ear diseases; evidence-based medicine; Humans; immunology; Otitis Media - drug therapy; Otolaryngology; Otolaryngology - statistics & numerical data; Pediatrics; pen-allergic; penicillin; Penicillins - adverse effects; Surveys and Questionnaires
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.25227

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 Laryngoscope, 125:1822–1826, 2015