Impact of parent-reported antibiotic allergies on paediatric Antimicrobial Stewardship Programs.

Background: Antimicrobial stewardship (AMS) is crucial for optimising antimicrobial use and restraining emergence of antimicrobial resistance. The overall increase in reported antibiotic allergies in children can pose a significant barrier to AMS, but its impact on clinical AMS care in children has not been addressed.

Objective: Compare the clinical outcomes for children with a reported antibiotic allergy label (AAL) with those with no AAL reviewed by AMS.

Method: A retrospective cohort study conducted in a paediatric tertiary hospital, capturing 1590 inpatient admissions reviewed under the AMS between 2017-2019. Logistic, log-binomial and Cox regression analyses were undertaken. Data collected included documented AAL, antibiotic prescriptions, principal diagnosis, admitting specialty, hospital length of stay, intensive care admissions and hospital readmissions.

Results: All 1590 paediatric patients were prescribed at least one antibiotic. AALs were recorded in 6.6% of patients; majority were beta-lactam (82%), mostly penicillins (71%). AALs increased with age (p<0.001); no gender effect was seen. Patients with AALs received more quinolones (p<0.001), lincosamides (p=0.001), aminoglycosides (p<0.001), and metronidazole (p=0.015), than patients with no AALs. In contrast, children with no AAL received more penicillin (p<0.001). Children with any AAL had marginally longer hospital length of stay, median (IQR) 7.0 (4.0, 15.0) days, than those without (median (IQR) 5.0 (3.75, 11.0) days, p=0.027).

Conclusion: This study is the first to show how AALs impact clinical outcomes in children under an AMS program. With recent advances in delabelling, early intervention in cases of AAL should target children under AMS services who are in immediate need of optimal antibiotic management.