{"doi":"10.1093/cid/ciaa653","title":"The Penicillin Allergy Delabeling Program: A Multicenter Whole-of-Hospital Health Services Intervention and Comparative Effectiveness Study","abstract":"BACKGROUND: Penicillin allergies are associated with inferior patient and antimicrobial stewardship outcomes. We implemented a whole-of-hospital program to assess the efficacy of inpatient delabeling for low-risk penicillin allergies in hospitalized inpatients. METHODS: Patients ≥ 18 years of age with a low-risk penicillin allergy were offered a single-dose oral penicillin challenge or direct label removal based on history (direct delabeling). The primary endpoint was the proportion of patients delabeled. Key secondary endpoints were antibiotic utilization pre- (index admission) and post-delabeling (index admission and 90 days). RESULTS: Between 21 January 2019 and 31 August 2019, we assessed 1791 patients reporting 2315 antibiotic allergies, 1225 with a penicillin allergy. Three hundred fifty-five patients were delabeled: 161 by direct delabeling and 194 via oral penicillin challenge. Ninety-seven percent (194/200) of patients were negative upon oral penicillin challenge. In the delabeled patients, we observed an increase in narrow-spectrum penicillin usage (adjusted odds ratio [OR], 10.51 [95% confidence interval {CI}, 5.39-20.48]), improved appropriate antibiotic prescribing (adjusted OR, 2.13 [95% CI, 1.45-3.13]), and a reduction in restricted antibiotic usage (adjusted OR, 0.38 [95% CI, .27-.54]). In the propensity score analysis, there was an increase in narrow-spectrum penicillins (OR, 10.89 [95% CI, 5.09-23.31]) and β-lactam/β-lactamase inhibitors (OR, 6.68 [95% CI, 3.94-11.35]) and a reduction in restricted antibiotic use (OR, 0.52 [95% CI, .36-.74]) and inappropriate prescriptions (relative risk ratio, 0.43 [95% CI, .26-.72]) in the delabeled group compared with the group who retained their allergy label. CONCLUSIONS: This health services program using a combination of direct delabeling and oral penicillin challenge resulted in significant impacts on the use of preferred antibiotics and appropriate prescribing.","journal":"Clinical Infectious Diseases","year":2020,"id":50952,"datarank":0.7755725992557229,"base_score":5.170483995038151,"endowment":5.170483995038151,"self_citation_contribution":0.7755725992557229,"citation_network_contribution":0.0,"self_endowment_contribution":0.7755725992557229,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":175,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9536,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":252356,"name":"Sara Vogrin","orcid":"0000-0002-1597-9421","position":1,"is_corresponding":false},{"id":253398,"name":"Susan Bury","orcid":null,"position":2,"is_corresponding":false},{"id":252357,"name":"Abby Douglas","orcid":"0000-0002-8314-352X","position":3,"is_corresponding":false},{"id":236379,"name":"Natasha E. Holmes","orcid":"0000-0001-8501-4054","position":4,"is_corresponding":false},{"id":252358,"name":"Nixon Tan","orcid":"0000-0001-9807-5462","position":5,"is_corresponding":false},{"id":252359,"name":"Natasha K. Brusco","orcid":"0000-0002-8825-5109","position":6,"is_corresponding":false},{"id":253399,"name":"Rebecca Hall","orcid":null,"position":7,"is_corresponding":false},{"id":252360,"name":"Belinda Lambros","orcid":"0009-0006-7048-4882","position":8,"is_corresponding":false},{"id":253400,"name":"Jacinta Lean","orcid":null,"position":9,"is_corresponding":false},{"id":253401,"name":"Wendy Stevenson","orcid":null,"position":10,"is_corresponding":false},{"id":252361,"name":"Misha Devchand","orcid":"0000-0001-8326-149X","position":11,"is_corresponding":false},{"id":253402,"name":"Kent Garrett","orcid":null,"position":12,"is_corresponding":false},{"id":252362,"name":"Karin Thursky","orcid":"0000-0002-7400-232X","position":13,"is_corresponding":false},{"id":252363,"name":"M. Lindsay Grayson","orcid":"0000-0002-3261-3149","position":14,"is_corresponding":false},{"id":252364,"name":"Monica A. Slavin","orcid":"0000-0002-8443-314X","position":15,"is_corresponding":false},{"id":106289,"name":"Elizabeth J. Phillips","orcid":"0000-0002-7623-3383","position":16,"is_corresponding":false},{"id":237223,"name":"Jason A. Trubiano","orcid":"0000-0002-5111-6367","position":17,"is_corresponding":false},{"id":252355,"name":"Kyra Chua","orcid":"0000-0001-8826-7137","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T20:39:29.006085Z","pmid":"32756983","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}