D3.48 - The delabeling of beta-lactam allergy does not change the antibiotic prescribing profile or alerts in Primary Care. The experience of a General Hospital

The delabeling of beta-lactam allergy enables the use of safer and more effective antibiotic therapy as well as reducing the risk of resistance.

The aim of this study was to evaluate whether after delabeling performed by the Allergy department during the antibiotic optimization program (PROA-A) or antibiotic stewardship, the alerts in electronic medical records of Primary Care are updated and whether the antibiotic prescription profile changes in Primary Care of reference area of our hospital (the city of  Alcorcón, Madrid Region).

During the PROA-Allergy intervention at HUFA, the tolerance to the betalactam recommended by the Infectious expert was assessed in patients labeled as allergic to beta-lactams and admitted. Based on a stratification of the risk of an allergic reaction, skin tests and/or provocation tests were performed. In outpatient consultations after discharge, the study was completed, and delabeling was carried out following the standard practices recommended by drug allergy guidelines.

Data on antibiotic prescriptions and alerts in primary care were collected from the Single Prescription Module of the Community of Madrid during the 3 years before and after the PROA-Allergy intervention.

A total of 179 patients were included between 2020 and 2023. The mean age was 74.48 ± 16.3 years, and 59.38% were women. The label was totally removed in 88 patients and partially removed in 31 patients. After total delabeling, there was no significant increase in beta-lactam use in primary care (before: 30.56%; after: 42.31%; p=0.34) or decrease in the use of quinolones (before: 35.5%; after: 36.33%; p=0.68) or macrolides (before: 26.53%; after: 33.33%; p=0.68). Regarding alerts to any beta-lactam, after total delabeling, 62.9% of patients still had active alerts. Among patients without total delabeling, 75% still maintained active alerts.

Our study demonstrates that there was no significant change in the antibiotic prescription profile (beta-lactam and non-beta-lactam antibiotics) in primary care after delabeling. No significant changes were observed in the removal of alerts either. One reason for this lack of effectiveness may be the lack of synchronization of drug allergy alerts between primary care and hospital electronic health record systems.