Antibiotic allergy De-Labeling: Teaching an old dog new tricks

Rationale Antibiotic allergy labels (AAL) significantly impact antibiotic prescribing and may lead to the inappropriate use of broad spectrum antibiotics which creates a public health concern. Infectious disease (ID) physicians from the Emerging Infections Network (EIN) of the Infectious Diseases Society of America (IDSA) were surveyed to determine their views, access and use of antibiotic allergy testing (AAT). Methods A 10-item online survey was distributed by the EIN in September 2015 to 1172 members practicing adult ID, 323 pediatric and 24 both. Two reminders were sent to non-respondents. Results Of 736/1,545 (48%), only 43% had skin prick/intradermal testing (SPT) available and 30% were either unaware of options or had none available. Although 78% overall suggested that a negative test would lead to AAL removal, those with > 15 years experience were significantly less likely to remove AAL (P<0.001). Most felt AAL removal would aid antibiotic selection (95%), appropriateness (92%), safety (74%) and antimicrobial-stewardship (AMS) (82%). Although 68% overall advocated incorporation of AAT into AMS, those with < 15 years experience were significantly more likely to support this (p=0.006). In settings of a remote reaction history, point-of-care testing (40%) was preferred to antibiotic desensitization (7%). Conclusions ID physicians perceive inadequate access to AAT services. Less experienced physicians were both more likely to view AAT as a means to remove AAL and advocate its incorporation into AMS. A generational shift appears to be occurring that should support AAT as a tool to improve antibiotic appropriateness