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College of Pharmacy

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South Carolina pharmacists advancing antibiotic stewardship through penicillin allergy skin testing

We often say the Doctor of Pharmacy degree (PharmD) is the most versatile degree in healthcare. Pharmacist roles continue to expand in many areas, especially in direct patient care. One such area is antibiotic stewardship. We are all called to be good stewards of our resources, and antibiotics are no exception. In general, antibiotic stewardship involves a multidisciplinary team working to optimize antibiotic selection, dose and duration based upon best available evidence. One challenge to effective antibiotic stewardship is the presence of antibiotic allergies, particularly a documented allergy to penicillin.

10% of Americans

Nearly 10% of Americans have a penicillin allergy documented in their medical records. While up to 90% of these allergies are either not severe or altogether inaccurate, they can certainly complicate antibiotic decision-making. Pharmacists in South Carolina are working to change that paradigm. In the summer of 2016, the Board of Pharmacy, Nursing and Medical Examiners, through a joint Healthcare Consortium committee, approved a pilot program at Prisma Health Richland for pharmacist-administered penicillin allergy skin testing. Patients hospitalized at Prisma Health with a penicillin allergy who were evaluated by the Infectious Diseases Team or Prisma Health Antimicrobial Stewardship and Support Team (PHASST) were eligible for testing.

“To date, we have performed approximately 40 skin tests and have screened over 125 additional patients. The results have been remarkable and led to favorable antibiotic changes in nearly 80% of patients tested,” said Dr. Julie Ann Justo, Clinical Assistant Professor at the USC College of Pharmacy and Infectious Diseases pharmacist at Prisma Health. Dr. Justo went on to add that often a thorough investigation of the allergy by a pharmacist is enough to help optimize antibiotic decision-making. “The patients really appreciate knowing the status of their allergy and whether they can take penicillin or related antibiotics,” stated Justo. Full results of this pilot project will be presented by Class of 2019 USC COP student, Nicole Griffith, at the American College of Clinical Pharmacy Global Meeting in Seattle, Washington in late October.

Dr. Majdi Al-Hasan, medical director of PHASST and Professor at the USC School of Medicine, recognizes the benefit. “Antibiotic stewardship is all about optimizing patient care. Our physicians and pharmacists at Prisma Health and USC are doing all they can to be good stewards of antibiotics in the era of increasing antibiotic resistance. Penicillin skin testing is one more tool we now have to ensure patients receive first-line therapy for serious infections.”

The Board of Pharmacy has since lifted the pilot restrictions and pharmacist-driven penicillin allergy skin testing is now approved throughout South Carolina, subject to appropriate credentialing, training and institution protocols and approval. Plans at Prisma Health include expansion into outpatient clinics and orthopedic surgery areas. A national certificate program for penicillin allergy assessment and skin testing available for pharmacists, physicians, physician assistants, nurses and associated trainees has recently been launched.

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