Reduction of vancomycin use in orthopedic patients with a history of antibiotic allergy

Objective: To reduce prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surg ery by using a targeted allergy consultation and penicillin allergy skin te sting. Patients and Methods: The participants in this practice improvement study w ere patients with a history of penicillin or cephalosporin allergy who were scheduled for elective orthopedic surgery and referred by orthopedic surge ons for allergy consultation and penicillin allergy skin testing between Se ptember 22, 1998, and April 15, 1999, The primary outcome measure was the p ercentage of participants who received prophylactic cefazolin during the st udy period compared with historical controls. Results: Of the 60 study patients, 59 received a penicillin allergy skin te st, 58 underwent orthopedic surgery, and 55 received antibiotic prophylaxis , Fifty-five patients had a history of allergy to penicillin, a cephalospor in, or both, and 5 had a history of nonspecific antibiotic allergy. Of the 59 patients, 55 (93%) had negative penicillin allergy skin test results. Fi fty-four (90%) of the 60 patients were given clearance by the allergist to receive cefazolin, Of the 55 study patients who received antibiotic prophyl axis, 6 (11%) received vancomycin compared with 38 (30%) of 127 historical controls (P less than or equal to.05). None of the study patients had an im mediate reaction to cefazolin or to vancomycin, Conclusion: Prophylactic vancomycin use in patients with a history of penic illin or cephalosporin allergy undergoing elective orthopedic surgery can b e reduced by a targeted allergy consultation and penicillin allergy skin te sting.