SHM Converge Scientific Abstract ePoster Gallery-Optimizing Antibiotic Stewardship: Implementing an Oral Amoxicillin Challenge to De-Label Penicillin Allergies at Morrell Internal Medicine Clinic

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This quality improvement initiative at Morrell Internal Medicine Clinic aims to improve antibiotic stewardship by safely removing inaccurate penicillin allergy labels from low-risk patients. The project addresses the common problem that many reported penicillin allergies are based on childhood rashes or illnesses that were incorrectly blamed on the antibiotic rather than a true allergic reaction. These mislabeled allergies often lead to unnecessary avoidance of penicillins and other beta-lactam antibiotics, which contributes to broader-spectrum antibiotic use and less optimal treatment.<br /><br />The clinic’s intervention is a structured oral amoxicillin challenge for carefully screened patients. Eligible patients are those with a history of a benign rash more than five years ago, without mucosal involvement or systemic symptoms. Patients with severe reactions, such as anaphylaxis or severe cutaneous adverse reactions, are excluded for safety.<br /><br />After informed consent, patients are scheduled for testing. On the day of the appointment, baseline vitals are recorded, followed by administration of amoxicillin. The protocol includes close monitoring with repeat vitals after 30 minutes and observation for one hour for any immediate adverse reaction. Emergency medications and equipment, including antihistamines, corticosteroids, epinephrine, and nebulizer treatments, are available onsite to ensure patient safety. If no reaction occurs, patients are instructed to monitor for delayed symptoms for up to 48 hours. Those who tolerate the challenge receive documentation stating they do not have a penicillin allergy.<br /><br />The initiative emphasizes careful screening, monitoring, and documentation. By de-labeling patients who are not truly allergic, the clinic expects to improve antibiotic selection, reduce unnecessary broad-spectrum antibiotic use, and enhance overall patient care.

Asset Subtitle

Graciela M. Luna

Meta Tag

Author List Christiane Martell, Christina Chen-Milhone, Daniela Carralero-Somoza, Graciela M. Luna, Monica Correa-Alfonzo, Nicole Canada, Sandra C. Madathilethu, Shreya Patel, DO

Category Innovations

Concept Penicillin Allergy De-labeling

Concept Oral Amoxicillin Challenge

Concept Antimicrobial Stewardship Program

Concept Low-Risk Allergy History

Concept Anaphylactic Shock

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health Medical Center

Presenting Author Graciela M. Luna

Track Quality Improvement

Keywords

penicillin allergy de-labeling

antibiotic stewardship

oral amoxicillin challenge

beta-lactam antibiotics

low-risk patients

allergy mislabeling

benign rash history

patient screening

adverse reaction monitoring

broad-spectrum antibiotic use

Penicillin Allergy De-labeling

Oral Amoxicillin Challenge

Antimicrobial Stewardship Program

Low-Risk Allergy History

Anaphylactic Shock