For example, the availability of an allergist for inpatient consultations and inpatient PST in the United States in community hospitals has been reported as 14% and 18%, respectively. Several strategies may present challenges for institutions limited by resources, legal authority, or the time-limiting nature of the intervention in relation to the volume of patients with pneumonia. Strategies to increase β-lactam use in patients with β-lactam allergies include pathways that incorporate patient assessment through historical review, direct oral challenges, penicillin skin testing (PST), and specialist evaluation. The presence of a β-lactam allergy has been associated with 21% lower use of β-lactams and increased use of non-β-lactam alternative antibiotics for the treatment of pneumonia. Preference is not specified however, antimicrobial stewardship programs (ASPs) often utilize first-line β-lactam use to avoid risks of alternative therapy. Recommendations for antibiotic treatment of pneumonias include regimens containing either β-lactam or non-β-lactam alternative therapy. ![]() Despite this, many patients with any β-lactam allergies are treated with non-β-lactam alternative therapies (eg, fluoroquinolones) that are associated with known risks including clinical failures and increased adverse events (eg, Clostridioides difficile infection ). Expert-recommended comprehensive allergy assessments typically incorporate the administration of structurally dissimilar β-lactam antibiotics. ![]() Clinically significant immunologically mediated cross-reactivity among β-lactams is associated with R-group side chain homology, and β-lactam antibiotics with dissimilar side chains are thought to be associated with lower rates of cross-reactivity.
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