Economic Viability of Penicillin Allergy Testing to Avoid Improper Clindamycin Surgical Prophylaxis

The study suggests that preoperative penicillin allergy testing may be an economically viable intervention to prevent unnecessary use of prophylactic clindamycin during otolaryngologic surgery. The break-even analysis was used to calculate the absolute risk reduction in baseline Clostridioides difficile infections and surgical site infections rate for penicillin allergy testing to be economically sustainable. The study found that penicillin allergy testing was economically sustainable if it could decrease the baseline CDI rate by an ARR of 1.06% or decrease the baseline SSI rate by an ARR of 1.34%. The probability of achieving these ARRs depended on the baseline CDI and SSI rates. The study suggests modifying current practice guidelines to recommend penicillin allergy testing in patients with an unconfirmed allergy prior to surgery.