student Department of Pharmacy Administration and Clinical Pharmacy, Peking University, China Beijing, China (People's Republic)
Background: β-lactam antibiotic-based therapies are recommended as first-line treatment for majority of primary care infections, yet rarely preferred in primary healthcare facilities (PHFs) in China. β-lactam allergy (BL-A) documentation, the vast majority of which are unverified and inaccurate, might impel unnecessary avoidance of β-lactam antibiotics, though with little supporting evidence.
Objectives: This study aimed to evaluate the association of documented BL-A with outpatient antibiotic prescribing at Chinese PHFs.
Methods: Setting: This was a cross-sectional study conducted among all 63 PHFs in Dongcheng district of Beijing, China in 2020. We extracted de-identified prescription data collected from the Beijing Prescription Reviewing System of Primary healthcare institutions (BPRSPHI). Outpatient visits with at least one antibiotic prescribed were eligible for inclusion. Exposure: Patient visits with a documentation of any BL-A, including penicillin allergy (Pen-A) and cephalosporin allergy (Cep-A), were defined as the treatment group; and those without any antibiotic allergy (AB-A) were taken as the control group. Main outcome measures: The outcomes were antibiotic use, considering individual antibiotic classes and 4 antibiotic groupings: (1) narrow-spectrum β-lactam antibiotics, (2) β-lactam alternative antibiotics, and (3) the Access and (4) the Watch group antibiotics according to the revised World Health Organization (WHO) AWaRe classification in 2021. Statistical analysis: We assessed the prescribing rates of different antibiotic classes. We used the chi-square test to compare proportions between groups. We applied logistic regression, with patient age, gender, and disease conditions being the covariates.
Results: Of 134,855 outpatient visits receiving antibiotics, the prevalence of BL-A documentation accounted for 5.8% (n=7,768), constituted of 7,251 (5.4%) visits with Pen-A and 680 (0.5%) visits with Cep-A record. Visits with documented BL-A (n=7,768) had significantly reduced odds of receiving narrow-spectrum β-lactam antibiotics (OR 0.69 [0.66-0.73]) and the Access antibiotics (OR 0.83 [0.79-0.88]), but associated with a higher use of β-lactam alternatives (OR 1.97 [1.89-2.08]) and the Watch antibiotics (OR 1.25 [1.18-1.32]), compared with visits without any documented AB-A (n=121,938).
Conclusions: We found significant difference of antibiotic prescribing between visits with and without BL-A documentation in Chinese PHFs. Outpatient visits with documented BL-A were less likely to receive narrow-spectrum β-lactams and the Access group antibiotics but more likely to receive the less effective and potentially more toxic β-lactam alternatives.
