2025 Southeastern Residency Conference

Title: Improving Antimicrobial Stewardship Through Penicillin Allergy Verification in a Rural Setting


Authors: Nicole M Kochmann, Abigail J. White, Bryan “Russ” Gunter


Objective: Decrease the number of incorrectly documented penicillin allergies in a rural population.  

Background: Approximately 10% of patients report a penicillin allergy, however, up to 90% of these are not true allergies. Inaccurate allergy documentation contributes to unnecessary use of broad-spectrum antibiotics, increasing the risk of antimicrobial resistance, adverse events, and healthcare costs. This project aimed to review current penicillin allergy documentation, identify areas for improvement, and determine patient eligibility for allergy testing or delabeling using the PEN-FAST tool. This tool helps identify low-risk patients who may be eligible for a direct oral challenge without the need for referral or skin testing.

Methods: 
A total of 101 adult patient charts with documented allergies to penicillin,amoxicillin, or ampicillin were reviewed and PEN-FAST scores calculated. Patients were excluded if they lacked a primary care provider, had no visits in the past three years, or had a history of severe reactions.

Results: Eight charts were excluded due to intolerance rather than allergies. With the remaining 93 charts: 86 lacked sufficient information to calculate a PEN-FAST score, while only seven had complete information. These results highlight gaps in our allergy documentation process, limiting use of the PEN-FAST tool.

Conclusion: The current allergy documentation process lacks necessary information, making it difficult to accurately assess PEN-FAST scores. There is a need for improved education on documenting allergies beyond just the reaction itself. Next steps for this project include implementing multidisciplinary education, developing educational tools, creating an in-house oral challenge protocol for low-risk patients (PEN-FAST < 3), and establishing a referral process for higher-risk patients (PEN-FAST ≥ 3).