Responders as percent of overall members in each category: Practice: Adult 537 (51% of 1063 members) 23 (59% of 39 members)

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1 Infectious Diseases Society of America Emerging Infections Network Report for Query: Antibiotic Allergies and Infectious Disease Practice Overall response rate: 744/1411 (52.7%) physicians responded from 1/18/12 to 2/21/12. Note: Not all respondents answered all questions, so totals for individual questions vary. Responders as percent of overall members in each category: Practice: Adult 537 (51% of 1063 members) Pediatrics 170 (61% of 277 members) Both 37 (52% of 71 members) Region: New England 51 (57% of 89 members) Mid Atlantic 112 (52% of 215 members) East North Central 107 (53% of 202 members) West North Central 65 (60% of 109 members) South Atlantic 136 (51% of 266 members) East South Central 40 (54% of 74 members) West South Central 52 (52% of 100 members) Mountain 45 (55% of 82 members) Pacific 123 (51% of 243 members) Puerto Rico 1 (17% of 6 members) Canada 12 (48% of 25 members) Years experience since ID fellowship: <5 years 141 (48% of 292 members) (44% of 435 members) (63% of 352 members) (58% of 332 members) Employment: Hospital/clinic 205 (52% of 393 members) Private/group practice 213 (53% of 402 members) University/medical school 281 (54% of 520 members) VA and military 38 (48% of 80 members) State gov t 7 (44% of 16 members) Primary hospital type: Community Non-university teaching University VA hospital or DOD City/county Other 170 (47% of 362 members) 230 (57% of 404 members) 276 (54% of 508 members) 37 (46% of 81 members) 23 (59% of 39 members) 8 (47% of 17 members) *Respondents were significantly more likely than non-respondents to have a pediatric practice (p=0.0055) and to have at least 15 years of ID experience (p<0.0001). Page 1

2 ANTIBIOTIC ALLERGY GENERAL EVALUATION AND MANAGEMENT Question 1. On your last month of clinical service, were you consulted about the antimicrobial management of a patient with an antibiotic allergy? No 162 (22%) Yes, from 1-4 times in that month 373 (50%) Yes, at least 5 times 209 (28%) Vignette: A 44-year-old man recently diagnosed with HIV is hospitalized with severe Pneumocystis jiroveci pneumonia. He has a history of sulfa allergy (mild rash) at age 12. Question 2. How would you treat this patient? Prescribe trimethoprim/sulfamethoxazole 235 (35%) Trimethoprim/sulfamethoxazole desensitization per protocol 210 (32%) with alternative agent until desensitization completed Use an alternative agent to avoid trimethoprim/sulfamethoxazole 220 (33%) Vignette: A 70-year-old woman with a history of penicillin allergy is hospitalized with a line infection, and vancomycin is initiated. S. aureus is isolated from the blood and is found to be susceptible to cefazolin and oxacillin. The primary physician wants to switch to one of the β-lactam antimicrobials. Thirty years previously, the patient developed a generalized pruritic rash which appeared approximately 6 hours after she took the first tablet of penicillin for a sore throat and resolved a day later. No other medications were taken at that time, and the patient has thereafter avoided all β-lactam Question 3. How would you treat this patient? Continue vancomycin without penicillin skin testing 77 (12%) Continue vancomycin and proceed with penicillin skin testing. If skin 158 (24%) tests are negative, discontinue vancomycin and start alternative agent Discontinue vancomycin and start B-lactam agent without penicillin 429 (64%) skin testing Page 2

3 Question 4. How often you use each of the following sources of information in the evaluation of a patient s antibiotic allergy: Direct history from the patient or family member "Allergies/alerts" as listed in the medical record Institutional records of prior administration / prescriptions Contact another entity (e.g. pharmacy, outside provider) for medication/allergy hx 7 25 Rarely 68 Occasionally 51 Usually Percent Note: Between 665 and 667 respondents provided a rating for each of the above items. Question 5. When taking a history of antibiotic allergy, indicate your perception of the usefulness of each of the following questions in the diagnosis of allergy: [1=very useful, 3=neutral, 5=not at all useful] Receipt of same antibiotic or class Characteristics of reaction Mean Median Patient recollection of reaction 1.6 Reported allergies to other agents Time to onset of reaction Patient age at initial reaction Other concurrent medications Purpose of taking antibiotic Very useful Neutral Note: Between 665 and 669 respondents provided a rating for each of the above items. Page 3

4 Penicillin Allergy and Testing for Penicillin Allergy Question 6. Is penicillin skin testing available at your practice setting? No 265 (40%) Yes 405 (60%) Question 6b. If yes, who performs penicillin skin testing in your facility? [Instructions were to check all that apply; numbers add to more than 100%] [401 respondents] By allergy/immunology physician 362 (90%) By ID physician (fellow or attending/consultant) 25 (6%) By pharmacist 23 (6%) By nurse practitioner/physician assistant 2 (0.5%) By other 12 (3%) Note: 20 respondents each selected more than one group that performed skin testing. The remaining respondents each selected only one group that performed skin testing. Question 7. Rank the following barriers to the implementation of B-lactam allergy testing in your practice: No barriers to testing reported by 210 (31%) respondents A score of 1 is the most important; 7 is the least important Availability of penicillin skin test materials No one available to perform test Mean Median Lack of proven usefulness of test 3.9 Concern for safety of skin test Cost / low reimbursement Legal concerns with skin test & use of penicillins Patient resistance to testing Most important Least important Note: Between 358 and 414 respondents provided a score for each of the above items. Page 4

5 Question 8. In a patient with a reported B-lactam allergy, is penicillin skin testing available before elective surgery at your practice setting? [Instructions were to check all that apply; numbers add to more than 100%] [660 respondents] Yes, it is available but is not routinely performed 268 (41%) Yes, it is routinely performed 9 (1%) No, it is not available 303 (46%) Regardless of availability, my facility gives vancomycin 127 (19%) (or other non-b-lactam) per protocol Question 9. In a patient with a reported B-lactam allergy (mild, non-anaphylactic) and S. aureus (MSSA) bacteremia, which option(s) below would you select? [Instructions were to check all that apply; numbers add to more than 100%] [668 respondents] Skin testing to confirm the history 77 (12%) A cephalosporin 543 (81%) Vancomycin 132 (20%) Daptomycin 81 (12%) A carbapenem 42 (6%) Other* 48 (7%) *Nafcillin/Oxacillin/Methicillin by 33 respondents Note: 119 respondents each selected more than one antibiotic option. 21 respondents selected skin testing only, while 56 respondents selected skin testing plus an antibiotic option. Question 10. Have you used or referred to the Joint Task Force on Practice Parameters. Drug Allergy (Oct 2010, Annals of Allergy, Asthma & Immunology)? No 628 (94%) Yes 42 (6%) Question 10b. What would be most useful in regards to management of patients with antibiotic allergies? [Instructions were to check all that apply; numbers add to more than 100%] [659 respondents] IDSA guidelines 606 (92%) Online training course 246 (37%) Education campaign for patients 216 (33%) Other* 43 (6%) *Education of providers, including ID physicians, primary care physicians, pharmacists, surgeons by 8 respondents; Experience (by 6 respondents); Sources of information including Sanford guide, UpToDate, primary medical literature / reviews, cystic fibrosis literature (by 7 respondents) Page 5