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Costs of  -Lactam Allergies
Selection and Costs of Antibiotics for Patients With a Reported  -Lactam Allergy
Eric J. MacLaughlin, PharmD;
Joseph J. Saseen, PharmD, BCPS;
Daniel C. Malone, PhD
Arch Fam Med. 2000;9:722-726.
Objective To evaluate antibiotic selection and the cost effect of reported  -lactam allergies.
Design Retrospective medical records review comparing antimicrobial selection and costs in patients with a reported -lactam allergy with a group in which no such allergy had been documented.
Setting University-based family medicine clinic.
Patients Patients who were prescribed at least 1 antibiotic for an upper respiratory tract infection, otitis media, sinusitis, and/or a urinary tract infection were eligible. One thousand two hundred one patients were identified via ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes. Four hundred sixty-five patients were initially identified and an additional 195 family members were eligible for inclusion.
Main Outcome Measures Comparison of antimicrobial selection and costs (by average wholesale price) between patients with and without a reported -lactam allergy.
Results Of the 660 patients eligible for inclusion, 99 (15%) had a documented -lactam allergy. Of the patients with a documented allergy, only 33% had a description of their purported reaction. The mean antibiotic cost for patients with a -lactam allergy was significantly higher compared with those without a -lactam allergy ($26.81 vs $16.28, respectively; P = .004). Patients with a -lactam allergy were more likely to have received a cephalosporin, macrolide, or a miscellaneous agent (eg, quinolone, tetracycline, or nitrofurantoin) (P = .001).
Conclusions Patients with a -lactam allergy had higher antibiotic costs and were more likely to receive a broader-spectrum antibiotic. Most patients with a reported allergy did not have a description of their reaction. Skin testing may be of use in detecting true -lactam allergies; however, further study is needed to determine its cost-effectiveness.
From the School of Pharmacy (Drs MacLaughlin, Saseen, and Malone) and the Department of Family Medicine (Dr Saseen), University of Colorado Health Sciences Center, Denver. Dr MacLaughlin is now with the School of Pharmacy, Texas Tech Health Sciences Center, Amarillo. Dr Malone is now with the College of Pharmacy, University of Arizona, Tucson.
RELATED ARTICLE
The Archives of Family Medicine Continuing Medical Education Program
Arch Fam Med. 2000;9(8):735.
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