Reported Penicillin Allergy Affects the Length of Hospital Stay in Patients with Erysipelas
DOI:
https://doi.org/10.2340/actadv.v106.adv-2026-0572Keywords:
erysipelas, penicillin, drug hypersensitivity, hospitalizationAbstract
Patients with a reported penicillin allergy are often treated with less effective antibiotics. This study examined the impact of anamnestic penicillin allergy on the length of hospital stay in patients with erysipelas, a condition for which penicillin is considered the first-line therapy and addresses the question: Does anamnestic penicillin allergy directly affect the length of hospital stay in patients with erysipelas? This retrospective analysis included patients who were admitted to the University Medical Center Regensburg for the treatment of erysipelas. The data analysed were sex, age at diagnosis, body temperature at admission, C-reactive protein, leucocyte count, procalcitonin, length of hospital stay, Charlson Comorbidity Index and antibiotic therapy. Patients were divided into 2 groups: with and without the label anamnestic penicillin allergy. Multiple regression analysis showed that patients with anamnestic penicillin allergy stayed 1.83 days longer in hospital than patients without anamnestic penicillin allergy (mean length of stay 12.17±7.01 days for patients with anamnestic penicillin allergy compared to 10.34±4.80 days for patients without anamnestic penicillin allergy, as determined by a t-test p=0.046). According to our data, anamnestic penicillin allergy is associated with prolonged hospital stay. Therefore, delabelling of penicillin allergy should be widely implemented.
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References
Sočan K, Sočan M. Trends in the epidemiology of erysipelas in Slovenia. Acta Dermatovenerol Alp Pannonica Adriat 2018; 27: 1–4. DOI: https://doi.org/10.15570/actaapa.2017.36
Bartholomeeusen S, Vandenbroucke J, Truyers C, Buntinx F. Epidemiology and comorbidity of erysipelas in primary care. Dermatology 2007; 215: 118–122. DOI: https://doi.org/10.1159/000104262
Borst C, Symmank D. Pathogenese, Klinik und Therapie des Erysipels. Hautnah 2022; 21: 55–62. DOI: https://doi.org/10.1007/s12326-022-00488-4
Paul-Ehrlich-Gesellschaft für Chemotherapie e. V. S2k-Leitlinie: Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen – Update 2018: 2. aktualisierte Version. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) 2019.
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59: 147–159. DOI: https://doi.org/10.1093/cid/ciu444
Luintel A, Healy J, Blank M, Luintel A, Dryden S, Das A, et al. The global prevalence of reported penicillin allergy: a systematic review and meta-analysis. J Infect 2025; 90: 106429. DOI: https://doi.org/10.1016/j.jinf.2025.106429
Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA 2019; 321: 188. DOI: https://doi.org/10.1001/jama.2018.19283
DesBiens M, Scalia P, Ravikumar S, Glick A, Newton H, Erinne O, et al. A closer look at penicillin allergy history: systematic review and meta-analysis of tolerance to drug challenge. Am J Med 2020; 133: 452–462. DOI: https://doi.org/10.1016/j.amjmed.2019.09.017
Borch JE, Andersen KE, Bindslev-Jensen C. The prevalence of suspected and challenge-verified penicillin allergy in a university hospital population. Basic Clin Pharmacol Toxicol 2006; 98: 357–362. DOI: https://doi.org/10.1111/j.1742-7843.2006.pto_230.x
Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet 2019; 393: 183–198. DOI: https://doi.org/10.1016/S0140-6736(18)32218-9
Pérez-Encinas M, Lorenzo-Martínez S, Losa-García JE, Walter S, Tejedor-Alonso MA. Impact of penicillin allergy label on length of stay and mortality in hospitalized patients through a clinical administrative national dataset. Int Arch Allergy Immunol 2022; 183: 498–506. DOI: https://doi.org/10.1159/000520644
S3- Leitlinie: Strategien zur Sicherung rationaler Antibiotika Anwendung im Krankenhaus - Update 2018: AWMF-Registernummer 092/001. AWMF – Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V; 2018.
Koch T, Leubner H, Brehm TT, Witte J. Penicillinallergie - Sicher und effektiv ausschließen. Deutsches Ärzteblatt 2023; 120: 822–824.
Deutsche Gesellschaft für Innere Medizin e. V. Überprüfung einer anamnestisch angegebenen Penicillinallergie vor einer Antibiotikatherapie. Klug entscheiden (DGIM); 2024. [cited 2025 October 6].
Wurpts G, Aberer W, Dickel H, Brehler R, Jakob T, Kreft B, et al. Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics. Allergo J Int 2019; 28: 121–151. DOI: https://doi.org/10.1007/s40629-019-0100-8
Porceddu SV, Haddad RI. Management of elderly patients with locoregionally confined head and neck cancer. Lancet Oncol 2017; 18: e274–e283. DOI: https://doi.org/10.1016/S1470-2045(17)30229-2
Hwabejire JO, Kaafarani HMA, Imam AM, Solis CV, Verge J, Sullivan NM, et al. Excessively long hospital stays after trauma are not related to the severity of illness: let’s aim to the right target! JAMA Surg 2013; 148: 956–961. DOI: https://doi.org/10.1001/jamasurg.2013.2148
Powell N, Honeyford K, Sandoe J. Impact of penicillin allergy records on antibiotic costs and length of hospital stay: a single-centre observational retrospective cohort. J Hosp Infect 2020; 106: 35–42. DOI: https://doi.org/10.1016/j.jhin.2020.05.042
Macy E, Contreras R. Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: a cohort study. J Allergy Clin Immunol 2014; 133: 790–796. DOI: https://doi.org/10.1016/j.jaci.2013.09.021
Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021; 70: 1–187. DOI: https://doi.org/10.15585/mmwr.rr7004a1
Ferreira A, Bolland MJ, Thomas MG. Meta-analysis of randomised trials comparing a penicillin or cephalosporin with a macrolide or lincosamide in the treatment of cellulitis or erysipelas. Infection 2016; 44: 607–615. DOI: https://doi.org/10.1007/s15010-016-0895-x
Sacco KA, Bates A, Brigham TJ, Imam JS, Burton MC. Clinical outcomes following inpatient penicillin allergy testing: a systematic review and meta-analysis. Allergy 2017; 72: 1288–1296. DOI: https://doi.org/10.1111/all.13168
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