Abstract：
To analyze the role played by the clinical pharmacist and its impact in antibiotic stewardship facing suspected allergy to beta-lactam antibiotics.
We performed two different independent bibliographic searches. A total of 35 articles were found, and the final number included in the study was 12. We analysed the articles and collected variables of efficacy, safety and applicability of evaluation tools applied to patients with suspected allergy to beta-lactams. Also, the variation in the consumption and prescription profile of alternative antibiotics was analyzed.
The selected studies analysed questionnaires, allergy delabeling, intradermal tests and oral challenge tests performed by pharmacists. Significant differences in the efficacy endpoint were found in 4 studies in favour of pharmaceutical intervention. In the study of Kwiatkowski et al, cefazolin use increased in surgical patients after pharmacist intervention (65 vs. 28%; p < 0.01). In a quasi-experimental study, the mean defined daily dose of aztreonam and the mean days of therapy per 1000 patients/day decreased (21.23 vs 9.05, p <0.01) and (8.79-4.24, p = 0.016), pre and post-intervention, respectively, increasing antibiotic de-escalations (p ≤ 0.01). In another quasi-experimental study, the prescription of restricted-use antibiotics decreased (42.5% vs. 17.9%, p < 0.01) and the use of pre-surgical prophylactic antibiotics alternative to cefazolin (81.9% vs 55.9%, p<0.01) in another study. Other study showed that the mean time per interview was 5.2 minutes per patient. No adverse events were reported in any study.
The pharmacist intervention in the evaluation of the patient with suspected allergy to beta-lactams is effective, safe and feasible to implement on daily clinical practice. The standardization of protocols to clarify the history of allergies and development of evaluation tools represent simple screenings to perform delabelling or refer to the Immunoallergology service, improving penicilins use and reducing the need for second line antibiotics. More studies are needed to standardize the desensitization tests made by pharmacists. However, despite these results, the involvement and leadership of the pharmacist in this area is limited and constitutes a future challenge for the profession.
We performed two different independent bibliographic searches. A total of 35 articles were found, and the final number included in the study was 12. We analysed the articles and collected variables of efficacy, safety and applicability of evaluation tools applied to patients with suspected allergy to beta-lactams. Also, the variation in the consumption and prescription profile of alternative antibiotics was analyzed.
The selected studies analysed questionnaires, allergy delabeling, intradermal tests and oral challenge tests performed by pharmacists. Significant differences in the efficacy endpoint were found in 4 studies in favour of pharmaceutical intervention. In the study of Kwiatkowski et al, cefazolin use increased in surgical patients after pharmacist intervention (65 vs. 28%; p < 0.01). In a quasi-experimental study, the mean defined daily dose of aztreonam and the mean days of therapy per 1000 patients/day decreased (21.23 vs 9.05, p <0.01) and (8.79-4.24, p = 0.016), pre and post-intervention, respectively, increasing antibiotic de-escalations (p ≤ 0.01). In another quasi-experimental study, the prescription of restricted-use antibiotics decreased (42.5% vs. 17.9%, p < 0.01) and the use of pre-surgical prophylactic antibiotics alternative to cefazolin (81.9% vs 55.9%, p<0.01) in another study. Other study showed that the mean time per interview was 5.2 minutes per patient. No adverse events were reported in any study.
The pharmacist intervention in the evaluation of the patient with suspected allergy to beta-lactams is effective, safe and feasible to implement on daily clinical practice. The standardization of protocols to clarify the history of allergies and development of evaluation tools represent simple screenings to perform delabelling or refer to the Immunoallergology service, improving penicilins use and reducing the need for second line antibiotics. More studies are needed to standardize the desensitization tests made by pharmacists. However, despite these results, the involvement and leadership of the pharmacist in this area is limited and constitutes a future challenge for the profession.
摘要：
目的：分析临床药师在疑似β-内酰胺类抗生素过敏时的作用及其对抗菌药物管理的影响。
方法：我们进行了两个不同的独立书目检索。共找到35篇文章,纳入研究的最终人数为12。我们对文章进行了分析，并收集了疗效变量，应用于疑似β-内酰胺类过敏患者的评估工具的安全性和适用性.此外，分析了替代抗生素的用量和处方分布的变化.
结果：选定的研究分析了问卷，过敏脱标签，药剂师进行的皮内试验和口腔激发试验。在4项有利于药物干预的研究中发现了疗效终点的显着差异。在Kwiatkowski等人的研究中，药师干预后手术患者头孢唑林的使用增加(65vs.28%；p<0.01)。在一个准实验研究中,氨曲南的平均每日剂量和每1000名患者的平均治疗天数减少（21.23vs9.05，p<0.01）和（8.79-4.24，p=0.016），干预前和干预后，分别,增加抗生素降级(p≤0.01)。在另一项准实验研究中,限制使用抗生素的处方减少(42.5%vs.17.9%,p<0.01）和使用头孢唑啉的术前预防性抗生素（81.9％vs55.9％，p<0.01）在另一项研究中。其他研究表明，每位患者每次访谈的平均时间为5.2分钟。在任何研究中均未报告不良事件。
结论：药剂师干预对疑似β-内酰胺过敏患者的评估是有效的，在日常临床实践中安全可行。澄清过敏史的协议标准化和评估工具的开发代表了简单的筛查，以执行去标签或参考免疫变态反应服务，改善青霉素的使用并减少对二线抗生素的需求。需要更多的研究来标准化药剂师的脱敏测试。然而,尽管有这些结果,药剂师在这一领域的参与和领导是有限的，对该行业构成了未来的挑战。
方法：我们进行了两个不同的独立书目检索。共找到35篇文章,纳入研究的最终人数为12。我们对文章进行了分析，并收集了疗效变量，应用于疑似β-内酰胺类过敏患者的评估工具的安全性和适用性.此外，分析了替代抗生素的用量和处方分布的变化.
结果：选定的研究分析了问卷，过敏脱标签，药剂师进行的皮内试验和口腔激发试验。在4项有利于药物干预的研究中发现了疗效终点的显着差异。在Kwiatkowski等人的研究中，药师干预后手术患者头孢唑林的使用增加(65vs.28%；p<0.01)。在一个准实验研究中,氨曲南的平均每日剂量和每1000名患者的平均治疗天数减少（21.23vs9.05，p<0.01）和（8.79-4.24，p=0.016），干预前和干预后，分别,增加抗生素降级(p≤0.01)。在另一项准实验研究中,限制使用抗生素的处方减少(42.5%vs.17.9%,p<0.01）和使用头孢唑啉的术前预防性抗生素（81.9％vs55.9％，p<0.01）在另一项研究中。其他研究表明，每位患者每次访谈的平均时间为5.2分钟。在任何研究中均未报告不良事件。
结论：药剂师干预对疑似β-内酰胺过敏患者的评估是有效的，在日常临床实践中安全可行。澄清过敏史的协议标准化和评估工具的开发代表了简单的筛查，以执行去标签或参考免疫变态反应服务，改善青霉素的使用并减少对二线抗生素的需求。需要更多的研究来标准化药剂师的脱敏测试。然而,尽管有这些结果,药剂师在这一领域的参与和领导是有限的，对该行业构成了未来的挑战。
