The role of a clinical pharmacist in spurious Penicillin allergy: a narrative review.

Background A label of penicillin allergy is held by 6-10% of the general population and 15-20% of inpatients. > 90% of these labels are found to be spurious after formal allergy assessment. Carrying an unnecessary label of penicillin allergy is not benign. Such patients may receive second line, more expensive antibiotics, representing a significant impediment to antimicrobial stewardship. Aim of the review To (a) Explain the burden of spurious penicillin allergy, and evaluate the safety of direct oral penicillin challenge in 'low risk' patients (b) appraise the place for a clinical pharmacist-led penicillin allergy de-labelling programme. Method Narrative review. Search engines: PubMed, Google Scholar and Cochrane reviews. Search criteria: English language; search terms: penicillin allergy, antimicrobial stewardship, antimicrobial resistance, clostridium difficile, vancomycin resistant enterococci, risk stratification, clinical pharmacist and direct oral provocation test Results Penicillin allergy labels are associated with: longer hospital stay, higher readmission rates, enhanced risk of surgical site infections, risk of Clostridioides difficile infection and Methicillin resistant Staphylococcus aureus infection, a delay in the first dose of an antibiotic in sepsis and higher healthcare costs. A direct oral penicillin challenge in 'low risk' patients has proven to be safe. Discussion Recent studies including those led by a clinical pharmacist have demonstrated safety of a direct oral penicillin challenge in 'low risk' patients. This intervention needs validation within individual health services. Conclusion Direct oral penicillin challenge reduces the adverse impact of spurious penicillin allergy. A pharmacist-led penicillin allergy de-labelling program needs further validation in prospective multi-centre studies

The potential of near and mid-infrared spectroscopy for rapid quantification of oleuropein, total phenolics, total flavonoids and antioxidant activity in olive tree (Olea europaea) leaves

Natural foods and food-related antioxidants such as phenolic phytochemicals are of great interest due to their preventive properties against oxidative damage. Olive tree leaves contain high quality and amount of phenolic compounds including oleuropein and therefore considered as nutraceutically valuable materials. The composition of olive leaves, its phenolics and antioxidant power are influenced by numerous factors causing great variation among samples. Additionally, traditional analytical methods performed to quantify these parameters in each product entail long and complicated sample preparation procedures, the use of toxic chemicals, skilled labors, instrumentation and sophisticated laboratory conditions. One appealing alternative is the use of infrared spectroscopy since it gives information about the food composition quickly and it is a multi-parametric and environmentally friendly choice. Therefore, we investigated the oleuropein, total phenolic content, total flavonoid content and antioxidant activity levels of 23 common cultivars of olive leaves harvested from Turkey and Italy using traditional reference methods and also developed near and mid-infrared based partial least squares regression (PLSR) models to predict these parameters without the need of sample preparation. Internal validations of the PLSR calibration models were done using full cross-validation and yielded very high correlation coefficients (0.95) and low errors in predictions (% standard error of cross-validation for parameters were lower than 7.54%). The levels of all the parameters of interest could be successfully predicted using both NIR and MIR instrumentation within seconds. Overall, infrared spectroscopy along with chemometrics exhibited great potential for future olive leave studies