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The following is a summary of “Improving Cefazolin Administration for Surgical Prophylaxis in Reported Penicillin Allergy: A Retrospective Study of a Health System Intervention,” published in the November 2024 issue of Allergy and Immunology by Belmont et al. 

Researchers conducted a retrospective study to assess whether a hospital-wide guideline could increase cefazolin use for surgical prophylaxis in patients with penicillin allergy labels.  

They conducted a retrospective cohort study of adult surgical patients with penicillin allergy labels. The intervention involved updated hospital-wide surgical guidelines recommending cefazolin as first-line (1L) prophylaxis for most patients with penicillin allergy labels. They compared pre-intervention and post-intervention groups. The primary outcome was cefazolin utilization, while secondary outcomes included alternative antibiotic use and severe allergic episodes, such as anaphylaxis.  

The results showed 7,187 patients with penicillin allergy labels and 8,945 surgical encounters (median age 61 [46-71]; 4,891 [68%] female). Cefazolin use increased from 2,256 (73%) to 3,390 (83%) (P < 0.001), with an adjusted odds ratio (OR) of 1.87 (95% CI 1.67-2.10). Clindamycin use decreased from 14% to 8% (P < 0.001) and gentamicin from 16% to 8% (P < 0.001), with no severe allergic reactions in guideline-directed therapy recipients. 

They found that a hospital-wide guideline improved cefazolin utilization in surgical patients with penicillin allergy labels without increasing the risk of severe allergic reactions. They recommended considering national and international guidance to enhance cefazolin administration in these patients further. 

Source: jaci-global.org/article/S2772-8293(24)00173-5/fulltext