Penicillin Allergy Delabeling: Provider Knowledge, Practice Patterns, and Barriers Among Internal Medicine Residents in a Large Urban Community Teaching Hospital.

BACKGROUND

Penicillin allergy is the most frequently reported drug allergy, yet up to 90% of labels are inaccurate. These erroneous labels contribute to suboptimal antibiotic use, higher healthcare costs, and increased antimicrobial resistance. Despite growing evidence supporting delabeling, provider hesitancy and knowledge gaps persist.

OBJECTIVE

The purpose of this study is to evaluate the awareness, confidence, and clinical decision-making of internal medicine residents regarding penicillin allergy delabeling within a large community hospital setting. Specifically, we seek to identify existing knowledge gaps, provider attitudes, and institutional barriers that may hinder appropriate delabeling efforts.

METHODS

A cross-sectional, anonymous electronic survey was administered to internal medicine residents at Ascension Saint Joseph Hospital in Chicago. The survey included questions on allergy knowledge, delabeling practices, confidence in risk stratification, and perceived barriers. Responses were analyzed using descriptive statistics and chi-square tests.

RESULTS

Of 66 residents invited, 42.4% (n = 28) responded. While 60.7% (n = 17) reported self-perceived knowledge on how to stratify beta-lactam allergy risk, only 12% (n = 2) felt confident in doing so. Familiarity with the PEN-FAST score increased with training level (postgraduate year (PGY)1: 0%; PGY3: 77%; p = 0.017). Half of the respondents had removed a penicillin allergy label, with significant differences by training level (p = 0.048). Major barriers included lack of institutional protocols (n = 23, 82.14%), insufficient knowledge (n = 18, 64.3%), and time constraints (n = 12, 42.86%).

CONCLUSIONS

Significant gaps exist in residents' knowledge and confidence regarding the delabeling of beta-lactam allergies. Lack of standardized training and protocols further hinders effective implementation. Structured educational interventions and institutional support are needed to promote safe and evidence-based delabeling practices as part of antimicrobial stewardship.