The study evaluated a pharmacist-led antimicrobial stewardship program aimed at optimizing preoperative antibiotics for surgical patients with penicillin allergy labeling (PAL).
The study found that patients with PAL are at risk of receiving suboptimal preoperative prophylaxis, and the use of cefazolin is the preferred preoperative antibiotic for many clean and clean-contaminated procedures. Cefazolin is a low-cost and well-tolerated antibiotic that does not share a side chain with other cephalosporins or penicillin, resulting in a low cross-reaction risk.
The program allowed clinical pharmacists to adjust orders of non-preferred antibiotics, such as clindamycin and vancomycin, to cefazolin for both non-severe and severe reactions in patients with PAL. The pharmacists reviewed the preoperative orders up to 24 hours in advance of the procedure and messaged the clinicians if adjustments were needed.
During the evaluation period, which covered 10,182 procedures/surgeries, the authors found that 15.4% (1,572) of patients had PAL. Of the 1,572 patients, 642 had previously reported a reaction as severe. Of the 971 patients who were ordered a preoperative antibiotic, 89.3% received a beta-lactam antibiotic, and 98.5% of those patients were administered cefazolin.
The results of the study showed an increase in the use of preferred preoperative antibiotics in patients with PAL, from 86% to 96.3%, with significant reductions in the use of non-preferred antibiotics (clindamycin from 2.1% to 0.2% and vancomycin from 3.2% to 0.4%, both P<0.001).
The authors suggest that optimizing preoperative antibiotics with cefazolin benefits patients with PAL by reducing side effects, lowering infusion time and cost, and decreasing the risk of resistance.