Why is penicillin not widely used these days?

In most cases, there is no penicillin allergy at all: Switching to other antibiotics has disadvantages and is often unnecessary

In the USA, around one in ten patients says they have had an allergic reaction to a penicillin. Usually, side effects such as gastrointestinal complaints or itching are the reason for the suspicion of an allergy. However, allergological tests show that around 95 percent of those affected are not allergic, according to the authors of the current JAMA publication (1). Similar figures exist for Germany: Here studies show that around three quarters of the patients who believe they are suffering from a penicillin allergy can even tolerate all beta-lactam antibiotics (2). In addition to penicillins, this important class of active ingredients also includes cephalosporins. “Even if there is actually an allergy to a certain penicillin, treatment with another penicillin or with a cephalosporin from this group is usually still possible,” says Gerd Fätkenheuer, DGI President and Head of Infectious Diseases at Clinic I for Internal Medicine at the University Hospital Cologne. Nevertheless, in acute cases, all beta-lactams are often not given because there is not enough time for allergological tests.

The fact that switching to other antibiotics also has tangible disadvantages is unfortunately not sufficiently anchored in the consciousness of doctors and patients.

PROF. DR. GERD FÄTKENHEUER

Because instead of the highly effective and well-tolerated beta-lactam antibiotics, patients then receive antibiotics from other substance classes, some of which are less effective and have more severe side effects, such as problematic colonization of the intestine Clostridium difficile-Bacteria. Clostridia can secrete toxins that can cause intestinal inflammation with severe diarrhea. The increased use of broad spectrum and reserve antibiotics also contributes to the development of resistance.

It makes sense for patients who suspect they have a penicillin allergy to have this clarified by an allergist.

"Because in acute cases you may not have enough time for a test and the doctor inevitably has to switch to other antibiotics," says Fätkenheuer. In order to contain the problem of the emergence of resistance and to treat patients effectively and with few side effects, the physicians have to scrutinize the statement "penicillin allergy" more critically and the often unnecessary switch to broad-spectrum and reserve antibiotics has to be significantly reduced, according to the DGI. For many years, the DGI has endeavored to sharpen knowledge about the sensible use of antibiotics and counter undesirable developments, such as unnecessary avoidance of penicillins, by offering intensive training in the field of rational antibiotic prescription ("Antibiotic Stewardship", ABS for short) - especially in the hospital sector . "New figures show that, thanks to the commitment of doctors and pharmacists in the ABS area, more penicillin and penicillin derivatives are being used again instead of cephalosporins and fluoroquinolones - in no way to the detriment of patients," says Professor Dr. med. Winfried Kern, Professor of Infectious Diseases at the Freiburg University Hospital and Head of the Academy for Infection Medicine, which organizes the ABS courses for the DGI.

Swell:

(1). Shenoy E. et al .: Evaluation and Management of Penicillin Allergy / A Review. JAMA.2019; 321 (2): 188-199 https://jamanetwork.com/journals/jama/article-abstract/2720732

(2) Trcka J. et al .: Penicillin therapy despite penicillin allergy? Plea for an allergological diagnosis if a penicillin allergy is suspected. Dtsch Arztebl 2004; 101 (43): A-2888 / B-2444 / C-2331 https://www.aerzteblatt.de/archiv/43978/Penicillintherapie-trotz-Penicillinallergie-Plaedoyer-fuer-eine-allergologische-Diagnostik-bei-Verdacht- on-penicillin allergy

(3.) Sachs B. et al .: Penicillin allergy: If the assumption does not apply. Dtsch Arztebl 2018; 115 (24): 20; doi: 10.3238 / PersPneumo.2018.06.15.005 https://www.aerzteblatt.de/archiv/198620/Penicillinallergie-(1)-Wenn-die-Vermutung-nicht-zutrifft

Contact for journalists:

German Society for Infectious Diseases
Press office Juliane Pfeiffer
P.O. Box 30 11 20
70451 Stuttgart
Tel .: 0711 8931-693
Fax: 0711 8931-167
Email: [email protected]

www.dgi-net.de

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