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Management of Patients with Suspected or Confirmed Antibiotic Allergy. Executive Summary of Guidance from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC)

Paño-Pardo JR1, Moreno Rodilla E2, Cobo Sacristan S3, Cubero Saldaña JL4, Periañez Párraga L5, del Pozo León JL6, Retamar-Gentil P7, Rodríguez Oviedo A8, Torres Jaén MJ9, Vidal-Cortes P10, Colás Sanz C4

1Division of Infectious Diseases. Hospital Clínico Universitario. Instituto de Investigación Sanitaria Aragón. Zaragoza, Spain. CIBER en Enfermedades Infecciosas (CIBERINFEC).
2Allergy Service, University Hospital of Salamanca, Salamanca, Spain. IBSAL (Institute for Biomedical Research of Salamanca), Salamanca, Spain. Department of Biomedical and Diagnostic Sciences, Salamanca Medical School, University of Salamanca, Salamanca, Spain. RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Madrid, Spain.
3Department of Pharmacy, Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
4Department of Allergy. Hospital Clínico Universitario. Instituto de Investigación Sanitaria Aragón. Zaragoza, Spain.
5Farmacia hospitalaria. Hospital Universitari Son Espases. CIBER en Enfermedades Infecciosas (CIBERINFEC).
6Division of Infectious Diseases. Department of Microbiology. Clínica Universidad de Navarra.
7Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain. Instituto de Biomedicina de Sevilla / Departamento de Medicina, Universidad de Sevilla / CSIC, Sevilla, Spain. Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC) (Instituto de Salud Carlos III, Madrid, Spain).
8Servicio de Medicina Intensiva. Hospital Universitari de Tarragona Joan XXIII. Tarragona, Spain. IISPV. CIBERES.
9Allergy Unit. Hospital Regional Universitario de Málaga-HRUM. Medicine Department, Universidad de Málaga-UMA, IBIMA-ARADyAL, Málaga, Spain
10Servicio de Medicina Intensiva. Hospital Universitario de Ourense. Orense, Spain.

J Investig Allergol Clin Immunol 2023; Vol. 33(2)
doi: 10.18176/jiaci.0859

Suspected or confirmed antibiotic allergy is a frequently encountered clinical circumstance that influences antimicrobial prescribing and often leads to the avoidable use of less efficacious and / or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs (ASP) in several countries. This guidance document aims to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. A panel of eleven members of involved Scientific Societies with expertise in the management of patients with suspected or confirmed antibiotic allergy formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence and formulated graded recommendations when possible. The answers to all questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy is recommended to improve antibiotic selection and, consequently clinical outcomes. A clinically-oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed -lactam allergy were formulated. Recommendations on the implementation and monitoring of the impact of the guidelines were formulated. ASP and allergists should design and implement activities that facilitate the most adequate antibiotic use in these patients.

Key words: Antibiotic allergy, Drug hypersensitivity reaction, Skin tests, Drug provocation test, Allergy label, Antimicrobial stewardship