Hostname: page-component-7479d7b7d-767nl Total loading time: 0 Render date: 2024-07-14T11:19:28.194Z Has data issue: false hasContentIssue false

The impact of beta-lactam allergy labels on hospitalized children

Published online by Cambridge University Press:  17 September 2020

Trahern W. Jones*
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah
Nora Fino
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
Jared Olson
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah Department of Pharmacy, Primary Children’s Hospital, Salt Lake City, Utah
Adam L. Hersh
Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah
Author for correspondence: Trahern W. Jones, E-mail:


Background and objectives:

Antibiotic allergy labels are common and are frequently inaccurate. Previous studies among adults demonstrate that β-lactam allergy labels may lead to adverse outcomes, including prescription of broader-spectrum antibiotics, increased costs, and increased lengths of stay, among others. However, data among pediatric patients are lacking, especially in the United States. In this study, we sought to determine the impact of β-lactam allergy labels in hospitalized children with regards to clinical and economic outcomes.


This retrospective cohort study included pediatric patients 30 days to 17 years old, hospitalized at Intermountain Healthcare facilities from 2007 to 2017, who received ≥1 dose of an antibiotic during their admission. Patients with β-lactam allergies were matched to nonallergic patients based on age, sex, clinical service line, admission date, academic children’s hospital or other hospital admission, and the presence of chronic, comorbid conditions. Outcomes included receipt of broader-spectrum antibiotics, clinical outcomes including length of stay and readmission, and antibiotic and hospitalization costs.


In total, 38,906 patients were identified. The prevalence of antibiotic allergy increased from 0.9% among those < 1 year peaked at 10.6% by age 17. Patients with β-lactam allergy received broader-spectrum antibiotics and experienced higher antibiotic costs than nonallergic controls. However, there were no differences in the length of stay, readmission rates, or total number of days of antibiotics between allergic and nonallergic patients.


Hospitalized pediatric patients with β-lactam allergy labels receive broader-spectrum antibiotics and experience increased antibiotic costs. This represents an important opportunity for allergy delabeling and antibiotic stewardship.

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


PREVIOUS PUBLICATION: Preliminary data from this study were presented at the 2019 IDWeek Conference, October 5, 2019, Washington, DC.


Norton, AE, Konvinse, K, Phillips, EJ, Broyles, AD. Antibiotic allergy in pediatrics. Pediatrics 2018;141(5). doi: 10.1542/peds.2017-2497.CrossRefGoogle Scholar
Macy, E, Poon K-Y T. Self-reported antibiotic allergy incidence and prevalence: age and sex effects. Am J Med 2009;122:778.e1778.e7.CrossRefGoogle ScholarPubMed
Vezir, E, Erkocoglu, M, Civelek, E, et al. The evaluation of drug provocation tests in pediatric allergy clinic: a single center experience. Allergy Asthma Proc 2014;35:156162.CrossRefGoogle ScholarPubMed
Ponvert, C, Perrin, Y, Bados-Albiero, A, et al. Allergy to β-lactam antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests. Pediatr Allergy Immunol 2011;22:411418.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
Desai, SH, Kaplan, MS, Chen, Q, Macy, E. Morbidity in pregnant women associated with unverified penicillin allergies, antibiotic use, and Group B Streptococcus infections. Perm J 2017;21.Google ScholarPubMed
Picard, M, Bégin, 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
Wu, JH, Langford, BL, Schwartz, KL, et al. Potential negative effects of antimicrobial allergy labelling on patient care: a systematic review. Can J Hosp Pharm 2018;71:2935.Google ScholarPubMed
Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016;315:18641873.CrossRefGoogle ScholarPubMed
Lucas, M, Arnold, A, Sommerfield, A, et al. Antibiotic allergy labels in children are associated with adverse clinical outcomes. J Allergy Clin Immunol Pract 2019;7:975982.CrossRefGoogle ScholarPubMed
Sousa-Pinto, B, Araújo, L, Freitas, A, Delgado, L. Hospitalizations in children with a penicillin allergy label: an assessment of healthcare impact. Int Arch Allergy Immunol 2018;176:234238.CrossRefGoogle ScholarPubMed
Parker, VA, Charns, MP, Young, GJ. Clinical service lines in integrated delivery systems: an initial framework and exploration. J Healthc Manag 2001;46:261275.Google ScholarPubMed
Feudtner, C, Feinstein, JA, Zhong, W, Hall, M, Dai, D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014;14:199.CrossRefGoogle ScholarPubMed
Vyles, D, Chiu, A, Routes, J, et al. Antibiotic use after removal of penicillin allergy label. Pediatrics 2018;141(5). doi: 10.1542/peds.2017-3466.CrossRefGoogle ScholarPubMed
Abrams, EM, Atkinson, AR, Wong, T, Ben-Shoshan, M. The importance of delabeling β-lactam allergy in children. J Pediatr 2019;204:291297.e1.CrossRefGoogle ScholarPubMed
Fleming-Dutra, KE, Shapiro, DJ, Hicks, LA, Gerber, JS, Hersh, AL. Race, otitis media, and antibiotic selection. Pediatrics 2014;134:10591066.CrossRefGoogle ScholarPubMed
Gerber, JS, Prasad, PA, Localio, AR, et al. Racial differences in antibiotic prescribing by primary care pediatricians. Pediatrics 2013;131:677684.CrossRefGoogle ScholarPubMed
Krah, N, Jones, TW, Lake, J, Hersh, AL. The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes and healthcare costs: a systematic review. Infect Control Hosp Epidemiol [In Press].Google Scholar
Kim, SH, Kim, KH, Kim, HB, et al. Outcome of vancomycin treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia. Antimicrob Agents Chemother 2008;52:192197.CrossRefGoogle ScholarPubMed
Liu, C, Bayer, A, Cosgrove, SE, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:138.CrossRefGoogle Scholar
Lee, S, Choe, PG, Song, KH, et al. Is cefazolin inferior to nafcillin for treatment of methicillin-susceptible Staphylococcus aureus bacteremia? Antimicrob Agents Chemother 2011;55:51225126.CrossRefGoogle ScholarPubMed
Wieczorkiewicz, JT, Lopansri, BK, Cheknis, A, et al. Fluoroquinolone and macrolide exposure predict Clostridium difficile infection with the highly fluoroquinolone- and macrolide-resistant epidemic C. difficile strain BI/NAP1/027. Antimicrob Agents Chemother 2015;60:418423.CrossRefGoogle Scholar
Johnson, S, Samore, MH, Farrow, KA, et al. 1999. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 341:16451651.CrossRefGoogle ScholarPubMed
Suzuki, H, Perencevich, EN, Livorsi, DJ, et al. Attributable mortality due to fluoroquinolone and extended-spectrum cephalosporin resistance in hospital-onset Escherichia coli and Klebsiella spp bacteremia: a matched cohort study in 129 Veterans Health Administration medical centers. Infect Control Hosp Epidemiol 2019;40:928931.CrossRefGoogle ScholarPubMed
Hecker, MT, Son, AH, Murphy, NN, et al. Impact of syndrome-specific antimicrobial stewardship interventions on use of and resistance to fluoroquinolones: an interrupted time series analysis. Am J Infect Control 2019;47:869875.CrossRefGoogle ScholarPubMed
Sousa-Pinto, B, Cardoso-Fernandes, A, Araújo, L, Fonseca, JA, Freitas, A, Delgado, L. Clinical and economic burden of hospitalizations with registration of penicillin allergy. Ann Allergy Asthma Immunol 2018;120:190194.e2.CrossRefGoogle ScholarPubMed
Supplementary material: File

Jones et al. supplementary

Tables S1-S2

Download Jones et al. supplementary(File)
File 17.7 KB