Outcomes in hospitalised patients with penicillin allergy: a systematic review and meta-analysis protocol

Elise Davis; Rebecca Gill; Eamonn Reda; Esther Thomas; Malikah Saba; Hanmin Chen; Tony Whitehouse

doi:10.1186/s13643-025-03038-0

Outcomes in hospitalised patients with penicillin allergy: a systematic review and meta-analysis protocol

Elise Davis
, Rebecca Gill
, Eamonn Reda
, Esther Thomas
, Malikah Saba
, Hanmin Chen
, Tony Whitehouse^*

^*Corresponding author for this work

Inflammation and Ageing

Research output: Contribution to journal › Article › peer-review

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Abstract

Introduction: When patients report a penicillin allergy (self-reported penicillin allergy, SRPA), clinicians alter their antibiotic management of the patient. However, fewer than 5% of SRPA have life-threatening reactions, and receiving narrower spectrum antibiotics may result in under treatment. Reports from community studies suggest that patients with SRPA are more likely to come to harm, but as SRPA implies exposure to healthcare, it is unclear whether additional harm is as a result of co-morbidities and the need to receive healthcare, rather than a harm in itself. This raises the question of how great an impact SRPA has on hospital and ICU mortality for patients admitted to hospital.

Methods and analysis: A literature search will be performed using MEDLINE, Embase and CINAHL (via OVID) in October 2024. The eligible studies will be of adult hospitalised patients with penicillin allergy compared with their non-allergic counterparts. We will extract demographic and outcome data including whether the patients were treated in ICU and mortality (28-days, in-ICU or in-hospital).

If possible, the results will be pooled for a meta-analysis by combining the all-cause mortality of patients at 28 days, in-ICU or in-hospital. Heterogeneity will be assessed using the I² or H² statistics if the number of included studies is less than 10.

Discussion: Previous reports of poor outcomes from SRPA are often based around increased risk of increased antibiotic use and antibiotic resistance. The requirement of SRPA to develop where there is exposure to healthcare and co-morbidities may mean that these outcomes are derived from poorer health rather than from SRPA perse. The impact of SRPA on hospitalised patients is less understood, with outcomes that are well-defined, such as mortality. This review will outline the differences that exist, and a meta-analysis may define the size of any differences.

Systematic review registration: PROSPERO CRD42024537658.

Original language	English
Article number	78
Number of pages	5
Journal	Systematic Reviews
Volume	15
Issue number	1
DOIs	https://doi.org/10.1186/s13643-025-03038-0
Publication status	Published - 12 Mar 2026

Keywords

Penicillin allergy
Meta-analysis
ICU
Antibiotic management
Mortality

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title = "Outcomes in hospitalised patients with penicillin allergy: a systematic review and meta-analysis protocol",

abstract = "Introduction: When patients report a penicillin allergy (self-reported penicillin allergy, SRPA), clinicians alter their antibiotic management of the patient. However, fewer than 5\% of SRPA have life-threatening reactions, and receiving narrower spectrum antibiotics may result in under treatment. Reports from community studies suggest that patients with SRPA are more likely to come to harm, but as SRPA implies exposure to healthcare, it is unclear whether additional harm is as a result of co-morbidities and the need to receive healthcare, rather than a harm in itself. This raises the question of how great an impact SRPA has on hospital and ICU mortality for patients admitted to hospital. Methods and analysis: A literature search will be performed using MEDLINE, Embase and CINAHL (via OVID) in October 2024. The eligible studies will be of adult hospitalised patients with penicillin allergy compared with their non-allergic counterparts. We will extract demographic and outcome data including whether the patients were treated in ICU and mortality (28-days, in-ICU or in-hospital). If possible, the results will be pooled for a meta-analysis by combining the all-cause mortality of patients at 28 days, in-ICU or in-hospital. Heterogeneity will be assessed using the I2 or H2 statistics if the number of included studies is less than 10. Discussion: Previous reports of poor outcomes from SRPA are often based around increased risk of increased antibiotic use and antibiotic resistance. The requirement of SRPA to develop where there is exposure to healthcare and co-morbidities may mean that these outcomes are derived from poorer health rather than from SRPA perse. The impact of SRPA on hospitalised patients is less understood, with outcomes that are well-defined, such as mortality. This review will outline the differences that exist, and a meta-analysis may define the size of any differences. Systematic review registration: PROSPERO CRD42024537658.",

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AU - Chen, Hanmin

AU - Whitehouse, Tony

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AB - Introduction: When patients report a penicillin allergy (self-reported penicillin allergy, SRPA), clinicians alter their antibiotic management of the patient. However, fewer than 5% of SRPA have life-threatening reactions, and receiving narrower spectrum antibiotics may result in under treatment. Reports from community studies suggest that patients with SRPA are more likely to come to harm, but as SRPA implies exposure to healthcare, it is unclear whether additional harm is as a result of co-morbidities and the need to receive healthcare, rather than a harm in itself. This raises the question of how great an impact SRPA has on hospital and ICU mortality for patients admitted to hospital. Methods and analysis: A literature search will be performed using MEDLINE, Embase and CINAHL (via OVID) in October 2024. The eligible studies will be of adult hospitalised patients with penicillin allergy compared with their non-allergic counterparts. We will extract demographic and outcome data including whether the patients were treated in ICU and mortality (28-days, in-ICU or in-hospital). If possible, the results will be pooled for a meta-analysis by combining the all-cause mortality of patients at 28 days, in-ICU or in-hospital. Heterogeneity will be assessed using the I2 or H2 statistics if the number of included studies is less than 10. Discussion: Previous reports of poor outcomes from SRPA are often based around increased risk of increased antibiotic use and antibiotic resistance. The requirement of SRPA to develop where there is exposure to healthcare and co-morbidities may mean that these outcomes are derived from poorer health rather than from SRPA perse. The impact of SRPA on hospitalised patients is less understood, with outcomes that are well-defined, such as mortality. This review will outline the differences that exist, and a meta-analysis may define the size of any differences. Systematic review registration: PROSPERO CRD42024537658.

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VL - 15

JO - Systematic Reviews

JF - Systematic Reviews

IS - 1

M1 - 78

ER -

Outcomes in hospitalised patients with penicillin allergy: a systematic review and meta-analysis protocol

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