Antibiotic allergy labels linked to longer hospital stays for children

Antibiotic allergy labels were tied to worsened clinical outcomes among hospitalized pediatric inpatients, as demonstrated by alternative antibiotic use and lengthened hospital stays, according to results of a first-of-its-kind study published in The Journal of Allergy and Clinical Immunology: In Practice.

“There are clear data to demonstrate that adults carrying an antibiotic allergy label have poorer clinical outcomes; however, the impact of an antibiotic allergy label in childhood is not well understood,” wrote the authors led by Michaela Lucas, MD, Department of Clinical Immunology, Princess Margaret Hospital, Perth, WA, Australia.

Antibiotic allergy labeling is an emerging public health issue, with self-reported antibiotic allergies ranging from 15% to 25% among inpatient adults. However, data in the pediatric cohort is limited. In one study, researchers reported antibiotic allergy rates of 6.1% in children ages 0-9, and 10.2% in those aged 10-19 years.

Adult patients with antibiotic allergy labels are more prone to experience lengthier hospital stays, readmission, prescription of second-line antibiotics (eg, vancomycin, quinolones, or macrolides), and complications, such as antibiotic-resistant infections. But the potential effects of antibiotic allergy labels in pediatric outcomes are unknown.

In this retrospective study, researchers analyzed whether parent-reported antibiotic allergy labeling affected clinical care in a gamut of pediatric patients. The team mined 1,672 inpatient admissions records (58% boys; average age, 6.81 years; 44.8% prescribed antibiotics) dated from April 2014 to April 2015 for documented antibiotic allergy labels, antibiotic prescriptions, admitting specialty, hospital length of stay, and hospital readmissions. Of note, data represented patients in an Australian tertiary pediatric center, with 5.3% of patients exhibiting at least one antibiotic allergy.

Overall, 85% of antibiotic allergy labels were for β-lactams (mostly unspecified penicillins). The team observed that there was a heightened frequency of antibiotic allergy labels with age (P < 0.001), a finding that fits with previous research. Researchers observed no sex effect. Pediatric patients with antibiotic allergy labels received more macrolide, quinolone, lincosamid, and metronidazole antibiotics compared to patients without antibiotic allergy labels.

The investigators found that, after controlling for age, sex, principal diagnosis, and specialty, patients with any antibiotic or β-lactam allergy labels experienced longer hospital stays, with an average stay of 3.8 days among those without labels vs 5.2 days among those with β-lactam allergy labels. These results were determined using univariate and multivariate regression.

The researchers highlighted the administration of broad-spectrum antibiotics to allergy-labeled patients with trivial infections as an area of concern with regard to antibiotic resistance and increased cost. Additionally, the team observed that 52.3% of the pediatric cohort with a penicillin or amoxicillin allergy label exhibited only mild to moderate reactions, such as rash, and thus could have been de-labeled after oral provocation challenge. De-labeling could have reduced adverse outcomes.

“De-labeling strategies implemented in childhood together with drug stewardship could reduce the use of alternative antibiotics and the associated increase in bacterial resistance,” Dr. Lucas and coauthors wrote. “Moreover, early de-labeling may be beneficial from a health economic point of view by reducing the prevalence and negative impact of allergy labels among children, the future adult population.”

Potential limitations of this study include its retrospective design, in which data accuracy relied solely on the record-keeping integrity of the staff at the time of admission, and coverage of only a single health-care center. These findings require further research, the investigators noted.

“The data highlight that antibiotic allergy labels already have a significant impact on clinical care in childhood,” concluded Dr. Lucas and coauthors. “Early intervention in the context of an antibiotic allergy label, for example, direct antibiotic challenges, may be feasible.”

This research was funded in part by the Perth Children’s Hospital Foundation.