ArticleBritish journal of clinical pharmacology2026
Identification of antibiotic allergies in children using prescribing patterns in the electronic medical record.
Article in British journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBy age three, 5%-75% of children have a documented antibiotic allergy (AL). Despite this prevalence, recognition remains low because of limited clinician knowledge and time. Our study evaluates a novel approach to identifying AL using electronic medical record (EMR) prescription patterns.
methodsAn EMR report was developed to identify paediatric encounters where adrenaline and/or an antihistamine was administered within 48 h of the last antibiotic dose. The first 100 cases were reviewed to refine exclusion criteria. Exclusions included diagnoses of eczema, or rash; antihistamine/adrenaline given before antibiotic initiation; adrenaline infusion; and antihistamines given after opioids or before blood products or monoclonal antibodies. Case notes from the cohort (2016-2023) were reviewed for suspected AL.
resultsThe EMR report identified 342 children, with 67 (20%) assessed as having a possible/probable AL. Of these, 38 (57%) had a documented allergy, whereas 29 (43%) were newly identified. Implicated antimicrobials were ceftriaxone (34%), flucloxacillin (19%) and amoxicillin ± clavulanic acid (18%). Immediate-severe reactions accounted for eight cases (12%), including anaphylaxis (9%), angioedema (1%) and respiratory distress (1%). Most reactions (82%) were nonimmediate, nonsevere reactions. One case (1%) was a nonimmediate, severe, serum-sickness-like reaction. Of the 29 newly identified cases, six (21%) were considered too high of a risk to undergo antibiotic challenge, and three (13%) had a positive challenge result.
conclusionsThis is the first study using EMR prescription patterns to identify AL in children. One in five children had a potential AL. This method could complement existing allergy identification practices.
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