Impact of Pre-operative Penicillin Allergy Evaluation on Surgical Prophylaxis

Impact of Pre-operative Penicillin Allergy Evaluation on Surgical Prophylaxis: a Randomized Controlled Trial

Use of first-line pre-operative antibiotic prophylaxis is the most effective measure to optimize perioperative outcomes. However, this is often not achieved due to unsubstantiated penicillin allergy labels. Penicillin allergy evaluation, when incorporated into routine pre-operative assessment, is potentially effective in optimizing choice of surgical prophylaxis. Despite the encouraging data mentioned above, there is a lack of randomized trials or local data to support this practice.

Inclusion Criteria:

• age 18 years or above
• planned for clean or clean-contaminated elective surgeries
• labelled allergy to penicillin group antibiotics on electronic patient record (ePR)

Exclusion Criteria:

• multiple antibiotic allergy
• history of severe cutaneous adverse reactions or other severe non-IgE-mediated hypersensitivity (e.g. haemolytic anaemia, organ dysfunction, serum sickness) due to beta-lactam antibiotics
• on systemic immunosuppressants
• pregnancy
• active or uncontrolled chronic urticaria
• mentally incompetent for informed consent