Evaluation of Antibiotic Allergy Documentation in Pediatric Patients

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Antibiotics are the most prescribed drug class in children and use often results in reports of adverse reactions. Of these adverse reactions, allergic reactions are documented with an incidence of 10% of all antibiotic prescriptions. Documentation of the details of the reaction is incomplete in as many as 66–84% of encounters leading to increased use of broad-spectrum antibiotics and associated adverse outcomes. The purpose of this study was to determine the incidence of complete antibiotic allergy documentation and how antibiotic selection was affected in pediatric patients.


A retrospective chart review of electronic medical records was conducted for pediatric patients admitted to a pediatric unit with a documented antibiotic allergy between September 1, 2015 and May 31, 2017.


The study sample included 536 encounters, 424 individual patients and 689 total allergies. Of all admissions during the study period, 10.3% of encounters had at least one antibiotic allergy documented. Approximately 40% of the encounters were in patients aged 12–17 years. A specific antibiotic was identified in 510 instances (74.0%) whereas an antibiotic class was documented in the remaining 179 instances (26.0%). Amoxicillin was the most commonly reported agent (25.4%). Rash (33.5%) and hives (14.8%) were the most commonly reported reactions. No reaction documentation was found in 78 entries (11.3%). Sixty-six entries (9.6%) did not include a date of occurrence and 452 (65.6%) did not include any specific comments regarding the allergy. Following evaluation of allergy documentation, 87 entries (12.6%) were classified as complete. Empiric broad-spectrum antibiotics were prescribed in 184 encounters (82.5%) compared with narrow-spectrum antibiotic therapy in 39 encounters (17.5%) when an allergy was documented.


Incomplete documentation of antibiotic allergies was identified in almost 90% of encounters within the pediatric population admitted to Lehigh Valley Reilly Children’s Hospital. Due to the preferential use of broad-spectrum antibiotics in patients with documented antibiotic allergies, an initiative is underway to standardize evaluation and documentation of allergies in patients receiving care within the health network.





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Medicine and Health Sciences | Pediatrics


Department of Pediatrics, Department of Pediatrics Faculty

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