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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.

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