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Title: Challenging the Miracle Drug: Alterations in Prophylactic and Therapeutic Agents for Patients with Self-Reported Penicillin Allergies
Authors: Karetnick, Morgan
Advisors: Levin, Simon
Contributors: Laxminarayan, Ramanan
Department: Ecology and Evolutionary Biology
Class Year: 2016
Abstract: Antibiotic resistance is an incredibly pressing concern being addressed in the field of public health today. While numerous factors in medicine contribute to this growing problem, many of the reasons fall under the umbrella of inappropriate prescription and distribution of antibiotics. Every year, about 36 million Americans are admitted to U.S. registered hospitals. Based on the findings of previous studies, the medical histories recorded on patient charts upon hospitalization have a large influence on the prescribed course of treatment. One of the largest motives for altering generally recommended antibiotic guidelines is attributed to the self-declaration of an allergy. Nearly 1 in 10 Americans reports a serious allergy to penicillin or its analogs. However, no serious allergy truly exists in about 90 percent of cases. As these inaccurate self-reports of penicillin allergies often lead to the excess and inappropriate use of antibiotics, it is paramount to clarify these regimen alterations and understand their extensive influence on the development of both individual and global multi-drug resistant pathogens. This retrospective chart review focuses on a smaller subset of 1200 patients using data collected from a consortium of six diverse United States hospitals. The study aims to analyze the differences in therapeutic treatment agents between patients with and without self-reported penicillin allergies, and to analyze the ramifications of inappropriate alterations in relation to individual and global antibiotic resistance. The findings suggest that for many common reasons for hospitalization, such as pneumonia and surgical prophylaxis, there are large discrepancies in the antibiotics prescribed to these two patient groups. Penicillin allergic patients are often prescribed an excess of secondary alternatives in order to meet the same efficacy standards, of which a large amount are penicillins and beta-lactam derivatives, as front line agents. Additionally, among the penicillin allergic patients who were still prescribed a beta-lactam, almost all of the patients were able to continue their antibiotics for the complete recommended duration of therapy. In short, they were able to safely tolerate the antibiotics that they were allegedly allergic to. Thus, the generally inappropriate use of these second-line alternatives leads to many complications including increased risk of adverse effects and higher levels of toxicity. Patients are also more prone to the development and rise of individual multi-drug resistant pathogens, which likewise leads to global strains of these resistant pathogens. Special considerations need to be taken in light of these findings to establish universal criteria for the use of diagnostic tests to confirm these allergies, and to be cautious about overusing the already limited pool of available antibiotics.
Extent: 106 pages
Type of Material: Princeton University Senior Theses
Language: en_US
Appears in Collections:Ecology and Evolutionary Biology, 1992-2017

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