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Wijnakker R, van Maaren MS, Bode LGM, Bulatovic M, Hendriks BJC, Loogman MCM, Lutgens SPM, Middel A, Nieuwhof CMG, Roelofsen EE, Schoones JW, Sigaloff KCE, Sprikkelman AB, de Vrankrijker AMM, de Boer MGJ. The Dutch Working Party on Antibiotic Policy (SWAB) guideline for the approach to suspected antibiotic allergy. Clin Microbiol Infect 2023:S1198-743X(23)00178-7. [PMID: 37068548 DOI: 10.1016/j.cmi.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES Prudent handling of reported antibiotic allergy is an important aspect of antibiotic stewardship. The Dutch Working Party on Antibiotic Policy (SWAB) constituted a multidisciplinary expert committee to provide evidence-based recommendations for bedside decision making in antibiotic therapy in patients that report an antibiotic allergy. METHODS The guideline committee generated 12 key questions, most of which were population, intervention, comparison and outcome (PICO) questions relevant for both children and adults with suspected antibiotic allergy. For each question a systematic literature search was performed and reviewed for the best available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Quality of evidence was graded from very low to high and recommendations were formulated in structured discussions as strong or weak. RESULTS Sixty recommendations were provided for suspected allergy to beta-lactam antibiotics (BLA) and non-beta-lactam antibiotics (NBLA). Due to the absence of randomized controlled trials in this field, the underlying evidence was predominantly graded as low or very low. Available data supports that a detailed allergy history should always be performed and critically appraised. When cross-allergy between BLA groups is not to be expected due to absence of molecular similarity of the side chains, the patient can be safely exposed to the alternative BLA. An exception to this rule are severe delayed type reactions, in which reexposure to a BLA should only be considered after consultation of a multidisciplinary team. CONCLUSIONS Accumulated scientific data now supports a more liberal approach that better balances benefits of treatment with first choice and usually smaller spectrum antibiotics with appropriate avoidance of antibiotics in case of a truly high risk of a (severe) allergic reaction. In the Netherlands, a formal guideline was developed that provides recommendations for the approach towards suspected allergy to BLA and frequently used NBLA, thereby strongly supporting antimicrobial stewardship.
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Affiliation(s)
- R Wijnakker
- Department of internal medicine, Tergooi Medical Center, Hilversum & Department of infectious diseases, Leiden University Medical Center, Leiden.
| | - M S van Maaren
- Department of internal medicine, section allergology, Erasmus Medical Center, Rotterdam
| | - L G M Bode
- Department of medical microbiology and infectious diseases, Erasmus Medical Center, Rotterdam
| | - M Bulatovic
- Department of rheumatology and clinical immunology, University Medical Center Utrecht, Utrecht
| | - B J C Hendriks
- Department of clinical pharmacy and toxicology, Leiden University Medical Center, Leiden
| | - M C M Loogman
- General practioner, Dutch college of general practitioners
| | - S P M Lutgens
- Department of medical microbiology, Jeroen Bosch Hospital, 's-Hertogenbosch
| | - A Middel
- Department of internal medicine, University Medical Center Groningen, Groningen
| | - C M G Nieuwhof
- Department of internal medicine and allergology, Maastricht University Medical Center, Maastricht
| | - E E Roelofsen
- Department of clinical pharmacy, Medical Center Haaglanden, The Hague
| | - J W Schoones
- Directorate of Research Policy (formerly: Walaeus Library), Leiden University Medical Center, Leiden
| | - K C E Sigaloff
- Department of infectious diseases, Amsterdam University Medical Center, Amsterdam
| | - A B Sprikkelman
- Department of pediatric pulmonology and allergology, University Medical Center Groningen, Groningen
| | - A M M de Vrankrijker
- Department of pediatric infectious diseases, section infectious diseases, University Medical Center Utrecht, Utrecht
| | - M G J de Boer
- Department of infectious diseases and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
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Hammond C, Velard F, Ah Kioon MD, Come D, Hafsia N, Lin H, Ea HK, Liote F, Dudek M, Wallis GA, Paton K, Harris J, Kendall DA, Kelly S, Mercer L, Galloway J, Low A, Watson K, Lunt M, Dixon W, Symmons D, Hyrich K, Ntatsaki E, Watts RA, Mooney J, Scott DGI, Humphreys J, Verstappen SM, Marshall T, Lunt M, Hyrich K, Symmons DP, Khan A, Scott DL, Abraham A, Pearce MS, Mann KD, Francis RM, Birrell F, Moinzadeh P, Fonseca C, Hellmich M, Shah A, Chighizola C, Denton CP, Ong V, Croia C, Bombardieri M, Francesca A, Serafini B, Humby F, Kelly S, Migliorini P, Pitzalis C, Miles K, Heaney J, Sibinska Z, Salter D, Savill J, Gray D, Gray M, Jones GW, Greenhill CJ, Williams AS, Nowell MA, Jenkins BJ, Jones SA, McGovern J, Nguyen DX, Notley CA, Mauri C, Isenberg D, Ehrenstein M, Jacklin C, Bosworth AM, Bateman J, Allen M, Samani D, Davies D, Harris HE, Brannan S, Venters G, McQuillian A, Lovegrove F, Gibson J, Chinn D, Mclaren JS, Gordhan C, Stack RJ, Kumar K, Awad I, Raza K, Bacon P, Arkell P, Ryan S, Brownfield A, Packham J, Jacklin C, Bosworth AM, Wilkinson K, Roberts KJ, Moots RJ, Edwards SW, Headland SE, Perretti M, Norling L, Dalli J, Flower R, Serhan C, Perretti M, Naylor A, Azzam E, Smith S, Croft A, Duffield J, Huso D, Gay S, Ospelt C, Cooper M, Isacke C, Goodyear S, Rogers M, Buckley C, Greenhill CJ, Williams AS, Jones GW, Nowell MA, Moideen AN, Rosas M, Taylor PR, Humphreys IR, Jones SA, Vattakuzhi Y, Horwood NJ, Clark AR, Mueller AJ, Laird EG, Tew SR, Clegg PD, Orozco G, Eyre S, Bowes J, Flynn E, Barton A, Worthington J, Eyre S, Bowes J, Barton A, Amos C, Diogo D, Lee A, Padyukov L, Stahl EA, Martin J, Rantapaa-Dahlqvist S, Raychaudhuri S, Plenge R, Klareskog L, Gregersen P, Worthington J, Jani M, Chinoy H, Lamb J, Hazel P, Wedderburn L, Vencovsky J, Danko K, Lundberg I, O'Callaghan AS, Radstake T, Ollier WER, Cooper RG, Cobb J, Hinks A, Bowes J, Steel K, Sudman M, Marion MC, Keddache M, Wedderburn LR, Haas JP, Glass DN, Langefeld CD, Thomson W, Thompson SD, Cobb J, Hinks A, Flynn E, Hirani S, Patrick F, Kassoumeri L, Ursu S, Moncrieffe H, Bulatovic M, Bohm M, van Zelst B, Dolezalova P, de Jonge R, Wulffraat N, Newman S, Thomson W, Wedderburn L. Oral abstracts 7: Molecular mechanisms of disease--osteoarthritis * S1. Identification of novel osteoarthritis genes using zebrafish. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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