Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
Shopping Cart: ( empty )
You are here: Home > Journals > SH > SH24066
RESEARCH ARTICLE (Open Access)
Contents Vol 21(4)

First-line treatment with ceftriaxone for Neisseria gonorrhoeae infection less likely to be prescribed to patients with a penicillin allergy label: a retrospective audit of medical records

E. Durban https://orcid.org/0009-0000-8726-8111 A , K. English https://orcid.org/0000-0001-7345-0465 B * , R. Evans B and S. Martin https://orcid.org/0000-0002-9325-1647 B C
+ Author Affiliations
- Author Affiliations

A Research School of Biology, Australian National University, Canberra, ACT, Australia.

B Canberra Sexual Health Centre, Canberra Health Services, Garran, ACT, Australia.

C School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia.

* Correspondence to: karin.english@act.gov.au

Handling Editor: Michael Marks

Sexual Health 21, SH24066 https://doi.org/10.1071/SH24066
Submitted: 27 March 2024  Accepted: 19 June 2024  Published: 15 July 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC)

Abstract

Background

Gonorrhoea notifications have increased substantially in Australia over the past decade. Neisseria gonorrhoeae is already highly resistant to several antibiotics and so, alternatives to first-line treatment are generally strongly discouraged. The penicillin allergy label (AL) on patient medical records has previously been shown to influence prescribing practices, to the detriment of best-practice management and antimicrobial stewardship. This study aimed to understand how the penicillin AL influences antibiotic selection for gonorrhoea treatment at Canberra Sexual Health Centre.

Methods

A retrospective chart audit of gonorrhoea cases treated at Canberra Sexual Health Centre between January 2020 and October 2023 (n = 619 patients, n = 728 cases). Antibiotic selection was assessed according to penicillin AL status. Ceftriaxone selection was assessed according to penicillin allergy severity reported in the medical records and as determined using a validated antibiotic allergy assessment tool.

Results

Cases with a penicillin AL were more likely to receive antibiotics other than ceftriaxone (n = 7/41, 17.1%) than cases without the label (n = 8/687, 1.2%, P < 0.000). Most penicillin ALs had non-specific severity ratings in the medical records, but had insufficient information (n = 28/41, 68.3%) to apply the assessment tool. Those reported as low-severity in the records were more likely to receive ceftriaxone (n = 21/22, 95.5%) than those reported as moderate–high (n = 7/11, 63.6%) or unreported (n = 6/8, 0.75%).

Conclusions

Treatment of gonorrhoea in outpatient settings requires an understanding of penicillin allergy, and the ability to quickly and accurately identify penicillin-AL patients who can safely tolerate ceftriaxone. Institutionally endorsed penicillin allergy de-labelling protocols and access to easy-to-navigate prescribing advice within national sexually transmitted infection management guidelines would support this.

Keywords: antibiotic allergy, antibiotic allergy label, antibiotic prescribing, antibiotic selection, antimicrobial stewardship, gonorrhoea, Neisseria gonorrhoeae, penicillin allergy, penicillin allergy label, public health, sexual health, STI.

References

1  Wrenn RH, Trubiano JA. Penicillin allergy impact and management. Infect Dis Clin North Am 2023; 37(4): 793-822.
| Crossref | Google Scholar | PubMed |

2  Trubiano JA, Adkinson NF, Phillips EJ. Penicillin allergy is not necessarily forever. JAMA 2017; 318(1): 82.
| Crossref | Google Scholar | PubMed |

3  Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet 2019; 393(10167): 183-198.
| Crossref | Google Scholar | PubMed |

4  Blanca M, Romano A, Torres M, Férnandez J, Mayorga C, Rodriguez J, et al. Update on the evaluation of hypersensitivity reactions to betalactams. Allergy 2009; 64(2): 183-193.
| Crossref | Google Scholar | PubMed |

5  Romano A, Gaeta F, Valluzzi RL, Zaffiro A, Caruso C, Quaratino D. Natural evolution of skin-test sensitivity in patients with IgE-mediated hypersensitivity to cephalosporins. Allergy 2014; 69(6): 806-809.
| Crossref | Google Scholar | PubMed |

6  McGuinness MJ, Mccoy J, Bhowmick T. Antibiotic selection for suspected Neisseria gonorrhoeae infection among penicillin-allergic patients in the emergency department. Cureus 2021; 13(5): e15323.
| Crossref | Google Scholar |

7  STI Guidelines Australia. Gonorrhoea. 2021. Available at https://sti.guidelines.org.au/sexually-transmissible-infections/gonorrhoea/

8  Therapeutic Guidelines. Approach to Neisseria gonorrhoeae infection. 2019. Available at https://tgldcdp.tg.org.au/viewTopic?etgAccess=true&guidelinePage=Antibiotic&topicfile=neisseria-gonorrhoeae&guidelinename=Antibiotic&sectionId=toc_d1e128#toc_d1e128

9  Devchand M, Trubiano JA. Penicillin allergy: a practical approach to assessment and prescribing. Aust Prescr 2019; 42(6): 192-199.
| Crossref | Google Scholar | PubMed |

10  Pongdee T, Li JT. Evaluation and management of penicillin allergy. Mayo Clin Proc 2018; 93(1): 101-107.
| Crossref | Google Scholar | PubMed |

11  Unemo M, Shafer WM. Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future. Ann N Y Acad Sci 2011; 1230(1): 19-28.
| Crossref | Google Scholar |

12  Devchand M, Urbancic KF, Khumra S, Douglas AP, Smibert O, Cohen E, et al. Pathways to improved antibiotic allergy and antimicrobial stewardship practice: the validation of a beta-lactam antibiotic allergy assessment tool. J Allergy Clin Immunol Pract 7: 1063-1065.E5.
| Crossref | Google Scholar |

13  Australian Government Department of Health and Aged Care. National communicable disease surveillance dashboard. Australian Government Department of Health and Aged Care; 2024. Available at https://nindss.health.gov.au/pbi-dashboard/