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Burden of antibiotic allergy labels in Australian aged care residents: Findings from a national point-prevalence survey

Published online by Cambridge University Press:  19 March 2020

Laura Travis
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
Leon J. Worth
Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Melbourne, Australia Department of Medicine, University of Melbourne, Melbourne, Australia
Jason Trubiano
Department of Infectious Diseases, Austin Health, Heidelberg, Australia
Karin Thursky
National Centre for Antimicrobial Stewardship, Melbourne, Australia
Noleen Bennett*
Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Melbourne, Australia Department of Infectious Diseases, Austin Health, Heidelberg, Australia National Centre for Antimicrobial Stewardship, Melbourne, Australia Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
Author for correspondence: Noleen Bennett PhD, VICNISS Coordinating Centre, 792 Elizabeth St, Melbourne, 3000Australia. E-mail:



To determine the prevalence of antibiotic allergy labels (AALs) in Australian aged care residents and to describe the impact of labels on antibiotic prescribing practices.


Point-prevalence survey.


Australian residential aged care facilities.


We surveyed 1,489 residents in 407 aged care facilities.


Standardized data were collected on a single day between June 1 and August 31, 2018, for residents prescribed an antibiotic. An AAL was reported if it was documented in the resident’s health record. Resident-level data were used to calculate overall prevalence, and antibiotic-level data were used to report relative frequency of AALs for individual antibiotics and classes.


Among 1,489 residents, 356 (24%) had 1 or more documented AALs. The AALs for penicillin (28.3%), amoxicillin or amoxicillin/clavulanic acid (10.5%), cefalexin (7.2%), and trimethoprim (7.0%) were most commonly reported. The presence of an AAL was associated with significantly less prescribing of penicillins (OR, 0.43; 95% CI, 0.31–0.62; P < .001) and significantly more prescribing of lincosamides (OR, 4.81; P < .001), macrolides (OR, 2.03; P = .007), and tetracyclines (OR, 1.54; P = .033). Of residents with AALs, 7 residents (1.9%) were prescribed an antibiotic that was listed on the allergy section of their health record.


A high prevalence of AALs was observed among residents of Australian aged care facilities, comparable to the prevalence of AALs in high-risk hospitalized patients. Significant increases in prescribing of lincosamide, macrolide, and tetracycline agents poses a potential risk to aged populations, and future studies must evaluate the benefits of AAL delabelling programs tailored for aged care settings.

Original Article
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Blumenthal, KG, Peter, JG, Trubiano, JA, Phillips, EJ.Antibiotic allergy. Lancet 2019;393:183198.CrossRefGoogle ScholarPubMed
Trubiano, JA, Thursky, KA, Stewardson, AJ, et al.Impact of an integrated antibiotic allergy testing program on antimicrobial stewardship: a multicenter evaluation Clin Infect Dis 2017;65:166174.CrossRefGoogle ScholarPubMed
Huang, KG, Cluzet, V, Hamilton, K, Fadugba, O.The impact of reported beta-lactam allergy in hospitalized patients with hematologic malignancies requiring antibiotics. Clin Infect Dis 2018;67:2733.CrossRefGoogle ScholarPubMed
Khumra, S, Chan, J, Urbancic, K, et al. Antibiotic allergy labels in a liver transplant recipient study. Antimicrob Agents Chemother 2017;61(5): pii: e00078-17.CrossRefGoogle Scholar
Knezevic, B, Sprigg, D, Seet, J, et al.The revolving door: antibiotic allergy labelling in a tertiary care centre. Intern Med J 2016;46:12761283.CrossRefGoogle Scholar
Macy, E, Poon, KYT.Self-reported antibiotic allergy incidence and prevalence: age and sex effects. Am J Med 2009;122:778, e771e777.CrossRefGoogle ScholarPubMed
Torda, A, Chan, V.Antibiotic allergy labels-the impact of taking a clinical history Int J Clin Pract 2018;72:e13058.CrossRefGoogle ScholarPubMed
Trubiano, JA, Pai Mangalore, R, Baey, YW, et al.Old but not forgotten: antibiotic allergies in general medicine (the AGM Study). Med J Aust 2016;204:273.CrossRefGoogle Scholar
Moran, RL, Devchand, M, Churilov, L, Warrillow, S, Trubiano, JA.The burden of antibiotic allergies in adults in an Australian intensive care unit: the BASIS study. Crit Care Resusc 2019;21:265273.Google Scholar
Charneski, L, Deshpande, G, Smith, SW.Impact of an antimicrobial allergy label in the medical record on clinical outcomes in hospitalized patients. Pharmacotherapy 2011;31:742747.CrossRefGoogle Scholar
Trubiano, JA, Leung, VK, Chu, MY, Worth, LJ, Slavin, MA, Thursky, KA.The impact of antimicrobial allergy labels on antimicrobial usage in cancer patients. Antimicrob Resist Infect Control 2015;4:23.CrossRefGoogle ScholarPubMed
Trubiano, JA, Cairns, KA, Evans, JA, Ding, A, Nguyen, T, Dooley, MJ, Cheng, AC.The prevalence and impact of antimicrobial allergies and adverse drug reactions at an Australian tertiary centre. BMC Infect Dis 2015;15:572.CrossRefGoogle ScholarPubMed
Lee, CE, Zembower, TR, Fotis, MA, et al.The incidence of antimicrobial allergies in hospitalized patients: implications regarding prescribing patterns and emerging bacterial resistance. Arch Intern Med 2000;160:28192822.CrossRefGoogle ScholarPubMed
Moran, R, Devchand, M, Smibert, O, Trubiano, JA.Antibiotic allergy labels in hospitalized and critically ill adults: a review of current impacts of inaccurate labelling. Br J Clin Pharmacol 2019;85:492500.CrossRefGoogle ScholarPubMed
Wu Hui-Chih, J, Langford, B, Schwartz, KL, et al.Potential negative effects of antimicrobial allergy labelling on patient care: a systematic review. CJHP 2018;71:2935.CrossRefGoogle Scholar
Macy, E, Contreras, R.Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study J Allergy Clin Immunol 2014;133:790796.CrossRefGoogle ScholarPubMed
van Dijk, SM, Gardarsdottir, H, Wassenberg, MW, Oosterheert, JJ, de Groot, MC, Rockmann, H.The high impact of penicillin allergy registration in hospitalized patients. J Allergy Clin Immunol Pract 2016;4:926931.CrossRefGoogle ScholarPubMed
Sade, K, Holtzer, I, Levo, Y, Kivity, S.The economic burden of antibiotic treatment of penicillin-allergic patients in internal medicine wards of a general tertiary care hospital. Clin Exp Allergy 2003;33:501506.CrossRefGoogle ScholarPubMed
Picard, M, Begin, P, Bouchard, H, et al.Treatment of patients with a history of penicillin allergy in a large tertiary-care academic hospital. J Allergy Clin Immunol Pract 2013;1:252257.CrossRefGoogle Scholar
Commonwealth of Australia. 2017–18 Report on the Operation of the Aged Care Act 1997. Canberra, Australia: Commonwealth of Australia; 2018.Google Scholar
National Centre for Antimicrobial Stewardship and Australian Commission on Safety and Quality in Health Care. Antimicrobial prescribing and infections in Australian residential aged care facilities: results of the 2018 Aged Care National Antimicrobial Prescribing Survey. Sydney, Australia: Australian Commission on Safety and Quality in Health Care 2019.Google Scholar
Blumenthal, KG, Lu, N, Zhang, Y, Li, Y, Walensky, RP, Choi, HK.Risk of methicillin-resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy: population based matched cohort study. BMJ 2018;361:k2400.CrossRefGoogle ScholarPubMed
Du Plessis, T WG, Jordan, A, et al.Implementation of a pharmacist-led penicillin allergy de-labelling service in a public hospital. J Antimicrob Chemother 2019;74:14381446.CrossRefGoogle ScholarPubMed
Marwood, J, Aguirrebarrena, G, Kerr, S, Welch, SA, Rimmer, J.De-labelling self-reported penicillin allergy within the emergency department through the use of skin tests and oral drug provocation testing. Emerg Med Australas 2017;29:509515.CrossRefGoogle ScholarPubMed
Blumenthal, KG, Li, Y, Hsu, JT, et al.Outcomes from an inpatient beta-lactam allergy guideline across a large US health system. Infect Control Hosp Epidemiol 2019;40:528535.CrossRefGoogle ScholarPubMed
Trubiano, JA, Worth, LJ, Urbancic, K, et al.Return to sender: the need to re-address patient antibiotic allergy labels in Australia and New Zealand. Intern Med J 2016;46:13111317.CrossRefGoogle ScholarPubMed