San Fransciso VA Beta-Lactam Test Dosing Protocol

What is it?

A formalized process for evaluating hospitalized patients with reported beta-lactam (penicillin, cephalosporin) allergies who need one of these antibiotics during their admission. Those who are deemed low risk for an adverse reaction will receive a one-time test dose (10% of the full treatment dose) of the recommended beta-lactam under observation. If the patient tolerates this, they will receive a full dose (100% of treatment dose) 30 minutes later. If there is no reaction after 60 minutes, the patient will continue on this antibiotic for treatment.

Why are we doing this?

By evaluating patients through a thorough allergy assessment, we can identify patients at low risk of having an adverse reaction, which will allow the patient to receive a more effective, less toxic, and/or less costly antibiotic to treat their infections. This can also decrease antibiotic resistance.

What is my role in this process?

• Obtain a detailed allergy history by asking the following questions
  • What is the name of the specific antibiotic that caused your allergic reaction?
  • When did the antibiotic reaction occur?
  • Can you describe the reaction you experienced?
  • How soon after taking the antibiotic did you experience the reaction?
  • How long did the reaction persist?
  • Did you require medical treatment or hospitalization for the reaction? If yes, what treatment was given?
  • Since your initial reaction, have you tolerated the same antibiotic later or perhaps an antibiotic related to the one you had a reaction to? [provide medication examples: amoxicillin, cephalexin, etc.]
• Evaluate patient for beta-lactam test dose based on risk assessment (see next section below)
  • Test doses may be performed in all inpatient areas except ED and OR areas (i.e. periop, PACU)
  • For patients with a history of severe, immediate reactions or anaphylaxis, test doses should be administered in the TCU. All other patients may undergo this protocol outside of the TCU.
• Contact ID Pharmacist for review and medication guidance prior to proceeding (pager: 415-223-8046)
• Refer to CPRS note titled “ID Assessment for Beta-Lactam Test Dose” completed by ID Pharmacist, which will contain information for all medications and nursing next orders
• Place orders using Beta-Lactam Test Dose Order Set. May contact ID Pharmacist for assistance.
• Notify patient’s nurse of expected date and time of beta-lactam test dose (must be Monday - Friday  from 10 am to 2 pm)
• Monitoring nurse will contact primary provider upon protocol completion or in the event of an adverse reaction

Beta-Lactam Test Dose Risk Assessment

Beta-Lactam Cross Reactivity Table