Morgan T Rose, Natasha E Holmes, Glenn M Eastwood, Sara Vogrin, Fiona James, Joseph F De Luca, Rinaldo Bellomo, Stephen J Warrillow, Michelle Phung, Sara L Barnes, Brendan Murfin, Ben Rogers, Belinda Lambros, Brennan Collis, Trisha N Peel, Monica A Slavin, Jason A Trubiano
PURPOSE: Critically ill patients are vulnerable to penicillin allergy labels that may be incorrect. The validity of skin testing in intensive care units (ICUs) is uncertain. Many penicillin allergy labels are low risk, and validated tools exist to identify those amenable to direct oral challenge. This pilot randomised controlled trial explored the feasibility, safety, and validity of direct enteral challenge for low-risk penicillin allergy labels in critical illness. METHODS: Consenting patients with a low-risk penicillin allergy label (PAL) (PEN-FAST risk assessment score < 3) in four ICUs (Melbourne, Australia) were randomised 1:1 to penicillin (250 mg amoxicillin or implicated penicillin) direct enteral challenge versus routine care (2-h post-randomisation observation for each arm)...
May 13, 2024: Intensive Care Medicine