{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T16:24:48Z","timestamp":1784823888103,"version":"3.55.0"},"reference-count":43,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T00:00:00Z","timestamp":1686096000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203132"],"award-info":[{"award-number":["203132"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["216355"],"award-info":[{"award-number":["216355"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["221719"],"award-info":[{"award-number":["221719"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Med Ethics"],"accepted":{"date-parts":[[2023,4,1]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Antibiotic allergies are commonly reported among patients, but most do not experience reactions on rechallenge with the same agents. These reported allergies complicate management of infections in patients labelled as having penicillin allergy, including serious infections where penicillin-based antibiotics are the first-line (most effective and least toxic) treatment option. Allergy labels are rarely questioned in clinical practice, with many clinicians opting for inferior second-line antibiotics to avoid a perceived risk of allergy. Reported allergies thereby can have significant impacts on patients and public health, and present major ethical challenges. Antibiotic allergy testing has been described as a strategy to circumvent this dilemma, but it carries limitations that often make it less feasible in patients with acute infections or in community settings that lack access to allergy testing. This article provides an empirically informed ethical analysis of key considerations in this clinical dilemma, using <jats:italic>Staphylococcus aureus<\/jats:italic> bacteraemia in patients with penicillin allergies as a case study. We argue that prescribing first-line penicillin-based antibiotics to patients with reported allergies may often present a more favourable ratio of benefits to risks, and may therefore be more ethically appropriate than using second-line drugs. We recommend changes to policy-making, clinical research and medical education, in order to promote more ethically acceptable responses to antibiotic allergies than the status quo.<\/jats:p>","DOI":"10.1136\/jme-2022-108648","type":"journal-article","created":{"date-parts":[[2023,6,7]],"date-time":"2023-06-07T13:23:39Z","timestamp":1686144219000},"page":"39-44","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Ethics of antibiotic allergy"],"prefix":"10.1136","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8001-5813","authenticated-orcid":false,"given":"Yu Yi","family":"Xiang","sequence":"first","affiliation":[{"name":"Western Health, Footscray, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George S","family":"Heriot","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Euzebiusz","family":"Jamrozik","sequence":"additional","affiliation":[{"name":"Ethox and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK"},{"name":"Royal Melbourne Hospital Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,6,7]]},"reference":[{"key":"2025092413564726000_50.1.39.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32218-9"},{"key":"2025092413564726000_50.1.39.2","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics7030071","article-title":"Patient and Prescriber views of penicillin allergy testing and subsequent antibiotic use: a rapid review","volume":"7","author":"Wanat","year":"2018","journal-title":"Antibiotics (Basel)"},{"key":"2025092413564726000_50.1.39.3","first-page":"29","article-title":"Potential negative effects of antimicrobial allergy labelling on patient care: a systematic review","volume":"71","author":"Wu","year":"2018","journal-title":"Can J Hosp Pharm"},{"key":"2025092413564726000_50.1.39.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0159406","article-title":"The impact of reporting a prior penicillin allergy on the treatment of Methicillin-sensitive Staphylococcus aureus bacteremia","volume":"11","author":"Blumenthal","year":"2016","journal-title":"PLoS One"},{"key":"2025092413564726000_50.1.39.5","doi-asserted-by":"publisher","DOI":"10.1111\/all.13168"},{"key":"2025092413564726000_50.1.39.6","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1080\/14787210.2019.1617132","article-title":"Self-reported beta-lactam intolerance: not a class effect, dangerous to patients, and rarely allergy","volume":"17","author":"Vyles","year":"2019","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2025092413564726000_50.1.39.7","doi-asserted-by":"crossref","first-page":"192","DOI":"10.18773\/austprescr.2019.065","article-title":"Penicillin allergy: a practical approach to assessment and prescribing","volume":"42","author":"Devchand","year":"2019","journal-title":"Aust Prescr"},{"key":"2025092413564726000_50.1.39.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.6510"},{"key":"2025092413564726000_50.1.39.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.19283"},{"key":"2025092413564726000_50.1.39.10","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1001\/jamainternmed.2020.0403","article-title":"Development and validation of a penicillin allergy clinical decision rule","volume":"180","author":"Trubiano","year":"2020","journal-title":"JAMA Intern Med"},{"key":"2025092413564726000_50.1.39.11","doi-asserted-by":"publisher","DOI":"10.1111\/all.13848"},{"key":"2025092413564726000_50.1.39.12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ394"},{"key":"2025092413564726000_50.1.39.13","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ308"},{"key":"2025092413564726000_50.1.39.14","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1177\/0009922819853014","article-title":"Cost and risk analysis of lifelong penicillin allergy","volume":"58","author":"Au","year":"2019","journal-title":"Clin Pediatr (Phila)"},{"key":"2025092413564726000_50.1.39.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2013.09.021"},{"key":"2025092413564726000_50.1.39.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaci.2017.12.283","article-title":"The increased risk of Methicillin-resistant Staphylococcus aureus and Clostridium difficile in patients with a documented penicillin allergy","volume":"141","author":"Blumenthal","year":"2018","journal-title":"J Allergy Clin Immunol"},{"key":"2025092413564726000_50.1.39.17","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt477"},{"key":"2025092413564726000_50.1.39.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.meegid.2013.03.020"},{"key":"2025092413564726000_50.1.39.19","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00134-14"},{"key":"2025092413564726000_50.1.39.20","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000091184.93122.09"},{"key":"2025092413564726000_50.1.39.21","doi-asserted-by":"publisher","DOI":"10.1086\/345476"},{"key":"2025092413564726000_50.1.39.22","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofy042","article-title":"Influence of reported penicillin allergy on mortality in MSSA bacteremia","volume":"5","author":"Turner","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"2025092413564726000_50.1.39.23","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1177\/0897190019841737","article-title":"Impact of reported beta-lactam allergy on management of Methicillin-sensitive Staphylococcus aureus bloodstream infections","volume":"33","author":"Veve","year":"2020","journal-title":"J Pharm Pract"},{"key":"2025092413564726000_50.1.39.24","doi-asserted-by":"publisher","DOI":"10.1097\/01.SMJ.0000145300.28736.BB"},{"key":"2025092413564726000_50.1.39.25","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofw153","article-title":"Improving antimicrobial stewardship by antibiotic allergy delabeling: evaluation of knowledge, attitude, and practices throughout the emerging infections network","volume":"3","author":"Trubiano","year":"2016","journal-title":"Open Forum Infect Dis"},{"key":"2025092413564726000_50.1.39.26","first-page":"815","article-title":"Penicillin allergy label persists despite negative testing","volume":"3","author":"Gerace","year":"2015","journal-title":"J Allergy Clin Immunol"},{"key":"2025092413564726000_50.1.39.27","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.anai.2016.03.030","article-title":"Immune-mediated reactions to vancomycin: a systematic case review and analysis","volume":"116","author":"Minhas","year":"2016","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2025092413564726000_50.1.39.28","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.jaip.2018.08.013","article-title":"Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome identified in the electronic health record allergy Module","volume":"7","author":"Wolfson","year":"2019","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025092413564726000_50.1.39.29","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1097\/ACI.0000000000000651","article-title":"The Economics of drug allergy","volume":"20","author":"Mattingly","year":"2020","journal-title":"Curr Opin Allergy Clin Immunol"},{"key":"2025092413564726000_50.1.39.30","doi-asserted-by":"crossref","first-page":"2858","DOI":"10.1016\/j.jaip.2020.04.059","article-title":"Penicillin allergy delabeling: a multidisciplinary opportunity","volume":"8","author":"Staicu","year":"2020","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025092413564726000_50.1.39.31","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.13.1493"},{"key":"2025092413564726000_50.1.39.32","doi-asserted-by":"publisher","DOI":"10.4997\/JRCPE.2018.306"},{"key":"2025092413564726000_50.1.39.33","doi-asserted-by":"crossref","DOI":"10.1186\/s12875-021-01465-1","article-title":"Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians","volume":"22","author":"Wanat","year":"2021","journal-title":"BMC Fam Pract"},{"key":"2025092413564726000_50.1.39.34","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz082"},{"key":"2025092413564726000_50.1.39.35","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit949"},{"key":"2025092413564726000_50.1.39.36","doi-asserted-by":"crossref","first-page":"15","DOI":"10.7243\/2050-120X-2-15","article-title":"Desensitization as a tool for beta-lactam antibiotic use in Methicillin sensitive Staphylococcus aureus infections","volume":"2","author":"Cash","year":"2013","journal-title":"J Pharm Technol Drug Res"},{"key":"2025092413564726000_50.1.39.37","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.01371-18","article-title":"Beyond penicillin: rapid desensitization for specific Flucloxacillin hypersensitivity","volume":"62","author":"Kwong","year":"2018","journal-title":"Antimicrob Agents Chemother"},{"key":"2025092413564726000_50.1.39.38","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1111\/jcpt.12751","article-title":"Successful desensitization to Cloxacillin in a patient with sepsis, with infective Endocarditis and clinical suspicion of hypersensitivity to penicillins, a case report","volume":"43","author":"Marin","year":"2018","journal-title":"J Clin Pharm Ther"},{"key":"2025092413564726000_50.1.39.39","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.aller.2012.06.003","article-title":"Desensitization in patients with beta-lactam drug allergy","volume":"41","author":"Yusin","year":"2013","journal-title":"Allergologia et Immunopathologia"},{"key":"2025092413564726000_50.1.39.40","doi-asserted-by":"publisher","DOI":"10.1086\/313435"},{"key":"2025092413564726000_50.1.39.41","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0210271","article-title":"Penicillin skin testing in Methicillin-sensitive Staphylococcus aureus bacteremia: a cost-effectiveness analysis","volume":"14","author":"Mattingly","year":"2019","journal-title":"PLoS One"},{"key":"2025092413564726000_50.1.39.42","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.jhin.2020.05.042","article-title":"Impact of penicillin allergy records on antibiotic costs and length of hospital stay: a single-centre observational retrospective cohort","volume":"106","author":"Powell","year":"2020","journal-title":"J Hosp Infect"},{"key":"2025092413564726000_50.1.39.43","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2222.2003.01638.x"}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jme-2022-108648","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T20:56:56Z","timestamp":1758747416000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/jme-2022-108648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,7]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12,14]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/jme-2022-108648"],"URL":"https:\/\/doi.org\/10.1136\/jme-2022-108648","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"value":"0306-6800","type":"print"},{"value":"1473-4257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,7]]}}}