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Management of Patients with Suspected or Confirmed Antibiotic Allergy: Executive Summary of Guidelines 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 JR1,2,3*, Moreno Rodilla E4,5,6,7, Cobo Sacristan S8,9, Cubero Saldaña JL2,10, Periañez Párraga L3,11, del Pozo León JL12, Retamar-Gentil P13,14,15, Rodríguez Oviedo A16,17,18, Torres Jaén MJ7,19,20,21, Vidal-Cortes P22, Colás Sanz C2,10,23*

1Division of Infectious Diseases, Hospital Clínico Universitario, Zaragoza, Spain
2Instituto de Investigación Sanitaria Aragon, Zaragoza, Spain
3Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
4Allergy Service, University Hospital of Salamanca, Salamanca, Spain
5Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
6Department of Biomedical and Diagnostic Sciences, Salamanca Medical School, University of Salamanca, Salamanca, Spain
7RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Madrid, Spain
8Department of Pharmacy, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
9Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
10Department of Allergy, Hospital Clínico Universitario, Zaragoza, Spain
11Farmacia Hospitalaria, Hospital Universitari Son Espases, Palma de Mallorca, Spain
12Division of Infectious Diseases, Department of Microbiology, Clínica Universidad de Navarra, Pamplona, Spain
13Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
14Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
15Departamento de Medicina, Universidad de Sevilla/CSIC, Sevilla, Spain
16Servicio de Medicina Intensiva, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
17Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
18Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES) Instituto de Salud Carlos III, Madrid, Spain
19Allergy Unit, Hospital Regional Universitario de Málaga-HRUM, Málaga, Spain
20Medicine Department, Universidad de Málaga-UMA, Málaga, Spain
21Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
22Servicio de Medicina Intensiva, Hospital Universitario de Ourense, Orense, Spain
23Departamento de Medicina, Universidad de Zaragoza, Zaragoza, Spain
* Coordinators

J Investig Allergol Clin Immunol 2023; Vol 33(2) : 95-101
doi: 10.18176/jiaci.0859

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription 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 in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) 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 the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was 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 ß-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients.

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