Rationalizing antibiotic prescribing for bacterial pneumonia in patients with reported penicillin allergy-a qualitative study.

Background: Penicillin allergy is commonly reported, yet often mislabelled. Such a label is associated with adverse outcomes in bacterial pneumonia. Despite recognition of the overlabelling of penicillin allergy and the awareness of potential adverse effects, there are limited data on the rationale for the management of patients with bacterial pneumonia and concomitant penicillin allergy. Objectives: To investigate the rationale guiding antibiotic prescription for bacterial pneumonia patients with reported penicillin allergy to improve outcomes. Methods: Semi-structured interviews were conducted between May and September 2022 to explore the management of patients with bacterial pneumonia and concomitant penicillin allergy. Data were analysed thematically using NVivo software. Recruitment was stopped when thematic saturation was reached. Results: Twenty doctors from the National University Hospital System, Singapore were interviewed. Role models and guidelines were found to be important in helping junior doctors make appropriate prescribing decisions. The ease of accessibility of detailed descriptions in allergy records and allergy services were among the concerns raised. Conclusions: Locally adapted approaches can be taken to appropriately label and delabel penicillin allergy, optimizing treatment and outcomes for patients with pneumonia and other common infectious diseases. We found that in an Asian urban context, role models and guidelines have been helping junior doctors make appropriate prescription decisions. More resources may be channelled into delabelling penicillin allergy to optimize patient outcomes.