Evaluation of Penicillin Allergy Documentation and Management at a Tertiary Hospital in Ebonyi State

Penicillin allergy labelling is common in hospitalised patients and significantly restricts antibiotic prescribing options, yet many documented allergies are inaccurate or poorly characterised, leading to suboptimal antibiotic therapy. This study evaluated penicillin allergy documentation and management practices at Alex Ekwueme Federal University Teaching Hospital in Abakaliki, Ebonyi State, South East Nigeria. A retrospective chart review was conducted for 210 inpatients with documented penicillin allergy over a 12-month period. Documentation completeness was assessed against recommended allergy recording standards including reaction type, severity, timing, and management at the time of reaction. Antibiotic prescribing patterns in allergy-labelled patients were also analysed. Results showed that allergy documentation was incomplete in 78.1 percent of records, with reaction description absent in 52.4 percent and reaction severity unrecorded in 63.8 percent. The majority of documented reactions (56.7 percent) were non-immune-mediated or non-specific symptoms rather than true allergic reactions. Penicillin-labelled patients received significantly more broad-spectrum antibiotics, fluoroquinolones, and vancomycin compared to non-labelled patients, contributing to adverse drug effects and unnecessary drug cost. Only 11.0 percent of labelled patients had ever undergone formal allergy evaluation. The study recommends implementing a structured penicillin allergy assessment pathway, pharmacist-led allergy history taking, and referral for formal allergy evaluation to optimise antibiotic therapy in allergy-labelled patients.

Keywords: penicillin allergy, allergy documentation, antibiotic stewardship, Ebonyi State, drug allergy management