{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T20:53:42Z","timestamp":1778014422967,"version":"3.51.4"},"reference-count":30,"publisher":"BMJ","issue":"2","funder":[{"name":"Australian Government, Department of Education and Training"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,1,8]]},"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate documentation of antimicrobial allergy and to determine prescribing adherence to local antibiotic guidelines for inpatients with and without reported penicillin allergy treated for infection in a National Health Service (NHS) context.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Data were collected at two English hospital NHS trusts over two time-periods: June 2016 and February 2017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cohort study. Trust 1 data were sourced from prospective point prevalence surveys. Trust 2 data were extracted retrospectively from an electronic report.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Inpatients treated for urinary tract infection (UTI), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and skin and soft tissue infection (SSTI). Data on allergy were collected, and antibiotic selection assessed for adherence to trust guidelines with differences between groups presented as adjusted ORs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 1497 patients were included, with 2645 antibiotics orders. Patients were treated for CAP (n=495; 33.1%), UTI (407; 27.2%), HAP (330; 22%) and SSTI (265; 17.7%). There were 240 (16%) patients with penicillin allergy. Penicillin allergy was recorded as allergy (n=52; 21.7%), side effect (27; 11.3%) and no documentation (161; 67.1%). Overall, 2184 (82.6%) antibiotic orders were guideline-adherent. Adherence was greatest for those labelled penicillin allergy (453 of 517; 87.6%) versus no allergy (1731 of 2128; 81.3%) (OR 0.52 (95% CI 0.37 to 0.73)\u2009p&lt;0.001). Guideline-adherence for CAP was higher if penicillin allergy (151 of 163; 92.6%) versus no allergy (582 of 810; 71.9%) (OR 0.20 (95% CI 0.10 to 0.37)\u2009p&lt;0.001). There was no difference in adherence between those with and without penicillin allergy for UTI, HAP or SSTI treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A relatively high proportion of patients had a penicillin allergy and two thirds of these had no description of their allergy, which has important implications for patient safety. Patients with penicillin allergy treated for CAP, received more guideline adherent antibiotics than those without allergy. Future studies investigating the clinical impact of penicillin allergy should include data on adherence to antibiotic guidelines.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026624","type":"journal-article","created":{"date-parts":[[2019,3,2]],"date-time":"2019-03-02T06:09:15Z","timestamp":1551506955000},"page":"e026624","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Adherence to antibiotic guidelines and reported penicillin allergy: pooled cohort data on prescribing and allergy documentation from two English National Health Service (NHS) trusts"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0801-3802","authenticated-orcid":false,"given":"Cameron J","family":"Phillips","sequence":"first","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"},{"name":"NIHR, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK"},{"name":"Clinical Microbiology and Public Health Laboratory, National Infection Service, Public Health England, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"},{"name":"Department of Medicine, University of Cambridge, Cambridge, UK"},{"name":"College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Gilchrist","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"},{"name":"NIHR, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona J","family":"Cooke","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Public Health Laboratory, National Infection Service, Public Health England, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryony D","family":"Franklin","sequence":"additional","affiliation":[{"name":"NIHR, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK"},{"name":"Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK"},{"name":"Research Department of Practice and Policy, UCL School of Pharmacy, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A","family":"Enoch","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Public Health Laboratory, National Infection Service, Public Health England, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"},{"name":"Department of Medicine, University of Cambridge, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael E","family":"Murphy","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Public Health Laboratory, National Infection Service, Public Health England, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reem","family":"Santos","sequence":"additional","affiliation":[{"name":"Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eimear T","family":"Brannigan","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison H","family":"Holmes","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust, London, UK"},{"name":"NIHR, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,3,1]]},"reference":[{"key":"2025101814115432000_9.2.e026624.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j3402"},{"key":"2025101814115432000_9.2.e026624.2","unstructured":"National Institute for Health and Clinical Excellence. 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