{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T02:05:12Z","timestamp":1774490712405,"version":"3.50.1"},"reference-count":59,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:00:00Z","timestamp":1659052800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Patients mislabeled with a penicillin allergy are often unnecessarily given prophylactic clindamycin. Thus, otolaryngologists may cause harm due to clindamycin's associated risk of <jats:italic>Clostridioides difficile<\/jats:italic> infections (CDI) and surgical site infections (SSI). The objective of this study was to determine the economic feasibility of penicillin allergy testing in preventing unnecessary clindamycin use among patients with an unconfirmed penicillin allergy prior to otolaryngologic surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A break\u2010even analysis was performed using the average cost of penicillin allergy testing and a CDI\/SSI to calculate the absolute risk reduction (ARR) in baseline CDI\/SSI rate due to clindamycin required for penicillin testing to be economically sustainable. The binomial distribution was used to calculate the probability that current penicillin testing can achieve this study's ARR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Preoperative penicillin testing was found to be economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of penicillin testing achieving these ARRs depended on the baseline CDI and SSI rates. When the CDI rate was at least 5% or the SSI rate was at least 7%, penicillin allergy testing was guaranteed to achieve economic sustainability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients mislabeled with a penicillin allergy, preoperative penicillin allergy testing may be an economically sustainable option to prevent the unnecessary use of prophylactic clindamycin during otolaryngologic surgery. Current practice guidelines should be modified to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>NA <jats:italic>Laryngoscope<\/jats:italic>, 133:1086\u20131091, 2023<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30329","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T10:03:20Z","timestamp":1659089000000},"page":"1086-1091","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9114-6571","authenticated-orcid":false,"given":"Matthew Y.","family":"Liu","sequence":"first","affiliation":[{"name":"Dell Medical School The University of Texas at Austin  Austin Texas USA"},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery University of Texas Health Science Center at San Antonio  San Antonio Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megana","family":"Challa","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery University of Texas Health Science Center at San Antonio  San Antonio Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1812-2105","authenticated-orcid":false,"given":"Edward D.","family":"McCoul","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Ochsner Health System  New Orleans Louisiana USA"},{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Tulane University School of Medicine  New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5468-3324","authenticated-orcid":false,"given":"Philip G.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery University of Texas Health Science Center at San Antonio  San Antonio Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2010.24.3475"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0904"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.2500\/ajra.2009.23.3349"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOO.0000000000000122"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22085"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22396"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-020-01269-2"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.20098"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/alr.22756"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25856"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2010.08.002"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13223-018-0289-y"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/588291"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkab091"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02176-12"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa124"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt129"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-021-22269-y"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2020.04.058"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1159\/000222672"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2019.34.e328"},{"key":"e_1_2_8_23_1","unstructured":"Beta\u2010lactam antibiotic skin testing and oral challenge: From the ACAAI 2015 Drug Allergy and Anaphylaxis Committee. 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