Abstract：
OBJECTIVE: Prudent handling of reported antibiotic allergies is an important aspect of antibiotic stewardship. The Dutch Working Party on Antibiotic Policy (SWAB) constituted a multidisciplinary expert committee to provide evidence-based recommendations for bedside decision-making in antibiotic therapy in patients that report an antibiotic allergy.
METHODS: The guideline committee generated 12 key questions, most of which were population, intervention, comparison, and outcome questions relevant to both children and adults with suspected antibiotic allergies. For each question, a systematic literature search was performed and reviewed for the best available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The quality of evidence was graded from very low to high, and recommendations were formulated in structured discussions as strong or weak.
RESULTS: Sixty recommendations were provided for suspected allergy to β-lactam antibiotics (BLAs) and non-β-lactam antibiotics. Owing to the absence of randomized controlled trials in this field, the underlying evidence was predominantly graded as low or very low. Available data support that a detailed allergy history should always be performed and critically appraised. When cross-allergy between BLA groups is not to be expected due to the absence of molecular similarity of the side chains, the patient can be safely exposed to the alternative BLA. An exception to this rule is severe delayed-type reactions in which re-exposure to a BLA should only be considered after consultation with a multidisciplinary team.
CONCLUSIONS: Accumulated scientific data now support a more liberal approach that better balances the benefits of treatment with first choice and usually smaller spectrum antibiotics with appropriate avoidance of antibiotics in case of a truly high risk of a (severe) allergic reaction. In The Netherlands, a formal guideline was developed that provides recommendations for the approach toward suspected allergy to BLA and frequently used non-β-lactam antibiotics, thereby strongly supporting antimicrobial stewardship.
METHODS: The guideline committee generated 12 key questions, most of which were population, intervention, comparison, and outcome questions relevant to both children and adults with suspected antibiotic allergies. For each question, a systematic literature search was performed and reviewed for the best available evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The quality of evidence was graded from very low to high, and recommendations were formulated in structured discussions as strong or weak.
RESULTS: Sixty recommendations were provided for suspected allergy to β-lactam antibiotics (BLAs) and non-β-lactam antibiotics. Owing to the absence of randomized controlled trials in this field, the underlying evidence was predominantly graded as low or very low. Available data support that a detailed allergy history should always be performed and critically appraised. When cross-allergy between BLA groups is not to be expected due to the absence of molecular similarity of the side chains, the patient can be safely exposed to the alternative BLA. An exception to this rule is severe delayed-type reactions in which re-exposure to a BLA should only be considered after consultation with a multidisciplinary team.
CONCLUSIONS: Accumulated scientific data now support a more liberal approach that better balances the benefits of treatment with first choice and usually smaller spectrum antibiotics with appropriate avoidance of antibiotics in case of a truly high risk of a (severe) allergic reaction. In The Netherlands, a formal guideline was developed that provides recommendations for the approach toward suspected allergy to BLA and frequently used non-β-lactam antibiotics, thereby strongly supporting antimicrobial stewardship.
摘要：
目的：谨慎处理报告的抗生素过敏是抗生素管理的一个重要方面。荷兰抗生素政策工作组（SWAB）成立了一个多学科专家委员会，为报告抗生素过敏的患者在抗生素治疗中的床边决策提供循证建议。
方法：指导委员会提出了12个关键问题，其中大多数是人口，干预，与疑似抗生素过敏的儿童和成人相关的比较和结果（PICO）问题。对于每个问题，进行了系统的文献检索，并根据建议评估等级审查了最佳可用证据。开发和评估（等级）系统。证据质量从很低到很高，并在结构化讨论中提出了强或弱的建议。
结果：对β-内酰胺类抗生素（BLA）和非β-内酰胺类抗生素（NBLA）的疑似过敏提供了60条建议。由于该领域缺乏随机对照试验，基础证据主要被分级为低或极低.现有数据支持应始终进行详细的过敏史并进行严格评估。当由于缺乏侧链的分子相似性而无法预期BLA组之间的交叉过敏时，患者可以安全地暴露于替代BLA。此规则的例外是严重的延迟型反应，其中，只有在咨询了多学科小组之后，才应考虑再次接触BLA。
结论：积累的科学数据现在支持了一种更自由的方法，该方法可以更好地平衡治疗与首选抗生素的益处，通常是较小范围的抗生素，并在真正高风险的情况下避免使用抗生素（严重）过敏反应。在荷兰,制定了正式的指南，为怀疑对BLA和经常使用的NBLA过敏的方法提供了建议，从而有力地支持抗菌药物管理。
方法：指导委员会提出了12个关键问题，其中大多数是人口，干预，与疑似抗生素过敏的儿童和成人相关的比较和结果（PICO）问题。对于每个问题，进行了系统的文献检索，并根据建议评估等级审查了最佳可用证据。开发和评估（等级）系统。证据质量从很低到很高，并在结构化讨论中提出了强或弱的建议。
结果：对β-内酰胺类抗生素（BLA）和非β-内酰胺类抗生素（NBLA）的疑似过敏提供了60条建议。由于该领域缺乏随机对照试验，基础证据主要被分级为低或极低.现有数据支持应始终进行详细的过敏史并进行严格评估。当由于缺乏侧链的分子相似性而无法预期BLA组之间的交叉过敏时，患者可以安全地暴露于替代BLA。此规则的例外是严重的延迟型反应，其中，只有在咨询了多学科小组之后，才应考虑再次接触BLA。
结论：积累的科学数据现在支持了一种更自由的方法，该方法可以更好地平衡治疗与首选抗生素的益处，通常是较小范围的抗生素，并在真正高风险的情况下避免使用抗生素（严重）过敏反应。在荷兰,制定了正式的指南，为怀疑对BLA和经常使用的NBLA过敏的方法提供了建议，从而有力地支持抗菌药物管理。
