About the Project
Penicillins are a key class of antibiotics used by maternity care providers during pregnancy, at delivery, and postpartum. For instance, it is the only appropriate treatment for syphilis infections in pregnancy. Yet when a patient’s file reports a penicillin allergy, providers avoid using it for fear of jeopardizing the patient’s health. There is, however, significant evidence that only portion of those labelled ‘penicillin allergy’ truly are, meaning many patients face risks from the unnecessary avoidance of penicillin. Some are treated with broad-spectrum antibiotics rather than penicillin, with adverse consequences for their rates of MRSA, VRE, and C difficile. Recognizing the value of penicillin allergy delabeling – essentially skin testing and an oral drug challenge to see if the patient is falsely labelled allergic – and the absence of a clear procedure of delabeling with the pregnant population, Dr. Amanda Jagdis set out to develop a consistent framework for delabeling of pregnant patients within Island Health.
This effort brought together all allergists practicing in Victoria, B.C, along with representatives from Obstetrics (Kelsey Mills), Family Practice (Susan Amundsen), Midwifery (Heather Nelson), and Pharmacy. After reviewing the existing literature on safety and outcomes of delabeling, the group achieved consensus about how to approach delabeling of pregnant patients in the safest possible way. They drafted a framework to guide this process, including how to identify appropriate candidates for delabeling in pregnancy, access and timing issues, method for delabeling, and monitoring and safety considerations. Their final challenge was ensuring that the results of delabeling could be easily communicated to those involved in the patient’s antepartum, intrapartum, and postpartum care. After presenting the pathway at the Island Health perinatal rounds, the group ensured the form was available on Pathways for those in Family Medicine, OBGYNs, and midwives to download for use.
Speaking about the process, Dr. Jagdis reflected how important it was to be able to engage across different provider groups. She has also seen the effects of the project in her own practice, “I’ve had people come into my office and tell me they are pregnant and are looking to have this test done. It feels really satisfying to have the project come full circle”.