Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026
Effect of Penicillin Allergy Label on Antibiotic Treatment Outcomes in Adult Patients with Rhinosinusitis.
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Levy Dylan A, Green Duncan G J, Liu Matthew, Liau Jonathan, Chen Philip G, McCoul Edward D
Аннотация
OBJECTIVE: Rhinosinusitis (RS) is prevalent in the ambulatory setting. When indicated, treatment with penicillin is recommended. However, up to 25% of the US population has a penicillin allergy label (PAL) within their health record, which can result in treatment with second-line antibiotics. The study explored the effect of PAL on clinical outcomes in RS.
STUDY DESIGN: Retrospective chart review.
SETTING: Ochsner Medical Centre.
METHODS: A chart review was performed in adult patients with RS who received antibiotics between 2011 and 2024. Treatment failure was defined as need for a second antibiotic within 30 days. Adverse events (AE) were indexed to a new diagnosis of diarrhea within 30 days. Odds ratio (OR) of success:AE was calculated and compared to standard of care, using Cohen's h to measure the effect size of nonpenicillin antibiotics.
RESULTS: 335,015 subjects who received antibiotics for RS were included. Of these, 55,557 (16.6%) had PAL. These patients were more likely to receive a nonpenicillin antibiotic for initial therapy (87.8%). Patients with a PAL had a slightly greater rate of treatment success (78.2% vs 75.8%, h = 0.057), but a greater AE rate (1.8% vs 1.7%, h-0.015). Among second-line treatments for patients with PAL, tetracycline had a superior OR of success: AE (0.983, 95% CI 0.906-0.894) compared to fluoroquinolones (0.842, 95% CI 0.843-0.831).
CONCLUSION: In patients with RS, PAL often leads to the prescription of a second-line antibiotic, which has decreased benefit-to-risk ratio compared to first-line treatment. This emphasizes the need for additional efforts to remove PALs from patients without true penicillin allergy.
STUDY DESIGN: Retrospective chart review.
SETTING: Ochsner Medical Centre.
METHODS: A chart review was performed in adult patients with RS who received antibiotics between 2011 and 2024. Treatment failure was defined as need for a second antibiotic within 30 days. Adverse events (AE) were indexed to a new diagnosis of diarrhea within 30 days. Odds ratio (OR) of success:AE was calculated and compared to standard of care, using Cohen's h to measure the effect size of nonpenicillin antibiotics.
RESULTS: 335,015 subjects who received antibiotics for RS were included. Of these, 55,557 (16.6%) had PAL. These patients were more likely to receive a nonpenicillin antibiotic for initial therapy (87.8%). Patients with a PAL had a slightly greater rate of treatment success (78.2% vs 75.8%, h = 0.057), but a greater AE rate (1.8% vs 1.7%, h-0.015). Among second-line treatments for patients with PAL, tetracycline had a superior OR of success: AE (0.983, 95% CI 0.906-0.894) compared to fluoroquinolones (0.842, 95% CI 0.843-0.831).
CONCLUSION: In patients with RS, PAL often leads to the prescription of a second-line antibiotic, which has decreased benefit-to-risk ratio compared to first-line treatment. This emphasizes the need for additional efforts to remove PALs from patients without true penicillin allergy.