Streamlining antibiotic allergy testing for elective surgery patients using smartphone based apps

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Antibiotic adverse drug reactions (ADRs), commonly known as "allergies", are a major burden on patients and hospitals. Currently, up to one in four Australian and American patients admitted to hospital will report an antibiotic "allergy" (so-called antibiotic allergy “labels” [AAL]), many of which limit appropriate antibiotic usage. In many instances, patients may undergo challenge with the antibiotic due to incorrect allergy reporting and recording. The nature of a patient’s antibiotic allergy and what antibiotics should be avoided are a common source of confusion for both doctors and patients alike. Penicillin allergy labels in the perioperative space have been associated with inferior patient (e.g. increased rates of periprosthetic infection), hospital (e.g. increased surgical time), and prescribing outcomes (e.g. vancomycin > cefazolin utilization), and conversely in observational and non-controlled studies penicillin allergy “de-labelling” has been associated with improved utilization of beta-lactams and patient outcomes. Further, whilst direct oral penicillin challenge has increasing observational evidence for safety and efficacy, it has not been applied to the perioperative assessment of orthopaedic patients reporting a penicillin allergy. This project is a collaboration between Austin Health, Alfred Health and Royal Melbourne Hospital. The PREPARE study is a feasibility and safety randomized control trial examining feasibility and safety of enhanced antibiotic allergy assessment and penicillin allergy testing in the perioperative setting in surgical patients planned for elective surgery. The PREPARE study will examine the utility of decision support (via smartphone app) utilizing a validated Antibiotic Allergy Assessment Tool9 for patients reporting a penicillin allergy in the perioperative arena in identifying those patients appropriate for a direct oral penicillin challenge in the perioperative clinic. PREPARE hopes to provide a useful point of care toolkit to improve clinician antibiotic allergy knowledge, antibiotic prescribing and medication safety, subsequently benefiting patients, clinicians and hospital networks.