A randomized controlled trial in the United Kingdom (ALABAMA trial) involving 823 adults from 51 general practices evaluated the impact of structured penicillin allergy assessment in primary care. All participants had a documented penicillin allergy and had received at least one antibiotic prescription within the past two years. They were randomly assigned to either a penicillin allergy assessment pathway (411) or usual care (412); 365 of the assessment group received testing.

At 12 months, significantly more patients in the assessment group received penicillin for conditions with recommended first-line treatment (18%; 72 of 401) compared with usual care (3%; 14 of 410), corresponding to an adjusted relative risk of 5.27 (95% CI, 3.03-9.18; P < .0001). Among tested patients, 335 (92%) were negative for penicillin allergy, and 321 (96%) were delabelled within 12 months, compared with only two (<1%) in usual care.

Although overall antibiotic prescriptions per patient were lower in the assessment group (2.3 vs 2.7; incidence rate ratio, 0.83; 95% CI, 0.72-0.95; P = .0094), the proportion receiving any antibiotic did not differ significantly. Non-penicillin antibiotic prescriptions were significantly lower in the assessment group (28% vs 42%; relative risk, 0.65; 95% CI, 0.54-0.79; P < .0001). There were no significant differences in serious adverse events (7% vs 8%; P > .99).

The incremental cost per patient was £33.93, with a 57.85% probability of cost-effectiveness at the £20,000 per QALY threshold. The study, predominantly involving White participants (97%) with an average age of 55 years, suggests structured review of penicillin allergy labels in primary care can increase appropriate penicillin use and improve targeted antibiotic prescribing without significant safety concerns. The study was funded by the National Institute for Health and Care Research. Full disclosures are available in the published study.

Full disclosures can be found in the published study.

Source: The Lancet Primary Care