In this episode I’ll:
1. Discuss an article about the impact of reported penicillin allergies.
2. Answer the drug information question “Can nafcillin cause hyperbilirubinemia?”
3. Share a resource for creating images for use in ICU education materials, protocols, and presentations.
Before we begin, I’d like to share a pearl from my book, A Pharmacist’s Guide to Inpatient Medical Emergencies:
“Know these common drug toxidromes: Anticholinergic, cholinergic, opioid, sympathomimetic” #pharmacists https://t.co/w0tP1mmQW7
— Pharmacy Joe (@PharmacyJoe) September 16, 2016
Article
Impact of Reported Beta-Lactam Allergy on Inpatient Outcomes: A Multicenter Prospective Cohort Study
Lead author: Derek R. MacFadden
Published in Clinical Infectious Diseases July 2016
Background
More evidence that having a reported “penicillin allergy” is bad for patients has been published. Pharmacists are in prime position to focus on patients with a reported penicillin allergy. We can help to clarify a patient’s allergies and in doing so prevent the negative consequences of having a reported (but false) penicillin allergy.
Methods
The authors prospectively evaluated the impact of reported allergy to beta-lactam antibiotics on clinical outcomes. The primary outcome was a composite measure of readmission for the same infection, acute kidney injury, Clostridium difficile infection, or drug-related adverse reactions requiring discontinuation.
Results
Among 507 patients, 19% reported beta-lactam allergy. When beta-lactam therapy was preferred, 35% of patients did not receive preferred therapy due to their report of allergy even though 52% of these patients reported non-severe beta-lactam reactions. Patients who did not receive preferred beta-lactam therapy were at significantly greater risk of adverse events (adjusted odds ratio 3.1) compared with those without reported allergy. In contrast, patients who received preferred beta-lactam therapy had a similar risk of adverse events compared with patients not reporting allergy.
Conclusion
The authors concluded:
Avoidance of preferred beta-lactam therapy in patients who report allergy is associated with an increased risk of adverse events. Development of inpatient programs aimed at accurately identifying beta-lactam allergies to safely promote beta-lactam administration among these patients is warranted.
Discussion
Beta-lactams are the “gold standard” therapy in many critically ill infected patients. While this study did not focus on ICU patients, there is every reason to believe that critically ill patients would be affected at least as much by unnecessary avoidance of beta-lactam antibiotics.
Drug information question
Q: Can nafcillin cause hyperbilirubinemia?
A: Rarely according to the prescribing information. Perhaps more importantly, hyperbilirubinemia correlates with decreased nafcillin clearance. This reduced nafcillin clearance is in turn associated with increased nausea, vomiting, diarrhea, and hepatotoxicity. If you encounter a patient on nafcillin with hyperbilirubinemia, consider an alternative antibiotic.
Resource
Canva.com is a free resource for creating infographics, presentation slides, flow charts and other engaging images. I use images created on Canva in my ICU education materials, protocols, and presentations. My visual antibiotic guide, vasopressor selection chart, and critical care workflow diagram were all created with Canva. You can download these resources in the free Pharmacy Nation community at pharmacyjoe.com/join.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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