Oral antibiotic adverse reactions after penicillin skin testing: multi‐year follow‐up

Abstract

Background: Long‐term follow‐up data on adverse drug reactions after oral antibiotic use in penicillin allergy history positive individuals with penicillin skin test done in advance of need are rare. Methods: Oral antibiotic associated adverse drug reactions in 83 penicillin skin test positive individuals were compared to a sex, age, and length of follow‐up matched sample of 166 penicillin skin test negative individuals, all of whom had at least one post penicillin skin test oral antibiotic. The mean post penicillin skin test follow‐up interval was 34.5 ± 16.6 months. There were 1655 total oral antibiotic exposures. Results: In penicillin skin test positive individuals, the adverse drug reaction rate was not significantly different with cephalosporin or non‐beta‐lactam use (P = 0.12). In penicillin skin test negative individuals the adverse drug reaction rate was significantly lower with cephalosporin vs. non‐beta‐lactam use (P = 0.005). Penicillin was safely used in penicillin skin test negative individuals. Overall cephalosporins caused fewer adverse drug reactions independent of penicillin skin test status (P = 0.005). Conclusions: Penicillin skin testing was only able to predict penicillin associated adverse drug reactions in penicillin skin test positive individuals. Excluding accidental penicillin exposure in penicillin skin test positive individuals, non‐beta‐lactams were associated with adverse drug reactions more often than penicillins or cephalosporins, independent of the penicillin skin test result. Cephalosporins were used as or more safely than non‐beta‐lactams in both penicillin skin test positive and negative individuals.