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https://repository.monashhealth.org/monashhealthjspui/handle/1/58093| Title: | Direct Oral Challenge for Penicillin Allergy: The International Network of Antibiotic Allergy Nations (iNAAN) Study. | Authors: | Cutfield T.;Redmond A.;Chakravorty A.;Meher-Homji Z.;Yuson C.;Crawford S.;Weeks G.;Ponnampalavanar S.S.S.;Katelaris C.;Tran P.;O'Hern J.;Godsell J.;Peel T.N.;Sandaradura I.;New D.;Holland C.;Mahony A.;Coghill S.;Hand C.;Williams J.;Bishop J.;Lambros B.;Day C.;Ierano C.;Roberts J.A.;Holmes N.E.;Klaic M.;Fernando S.L.;Trubiano J.A.;Fletcher L.R.;Vogrin S.;Powell N.;Peter J.;Li P.H.;Mitri E.A.;Copaescu A.M.;Turner N.A.;James F.;Paynter C.;Sullivan R.;Masoum M.S.;Rawlins M.;Mackay G.;Smith B.J.;Kilfoyle P.;Forster D.;Rose M.;Cowan R.;Alcorn K.;Brischetto A.;Barnes S. | Monash Health Department(s): | Respiratory and Sleep Medicine Infectious Diseases and Clinical Microbiology |
Institution: | (Roberts) UR UM 103, Division of Anesthesia Critical Care and Emergency and Pain Medicine, University of Montpellier, Nimes University Hospital, Nimes, France (Fernando) Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, NSW, Australia (Fernando) Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia (Cutfield) Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand (Mitri, Vogrin, Copaescu, James, Rose, Godsell, Holmes, Trubiano) Department of Infectious Diseases and Immunology, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, VIC, Australia (Mitri, Vogrin, Copaescu, James, Rose, Mahony, Ierano, Holmes, Trubiano) Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia (Mitri, Trubiano) National Allergy Centre of Excellence, Parkville, VIC, Australia (Fletcher) Department of Anaesthesia, Austin Health, Heidelberg, VIC, Australia (Fletcher) Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia (Fletcher) Data Analytics Research and Evaluation Centre, Austin Health, Heidelberg, VIC, Australia (Barnes) Monash Lung Sleep Allergy and Immunology, Monash Health, Clayton, VIC, Australia (Barnes) Department of Medicine, Monash University, Clayton, VIC, Australia (Powell) Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom (Peter, Day) Allergy and Immunology Unit, University of Cape Town Lung Institute, Mowbray, Cape Town, South Africa (Peter, Day) Division of Allergology and Clinical Immunology, Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, Observatory, Cape Town, South Africa (Li) Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Hong Kong, Pok Fu Lam, Hong Kong (Copaescu) Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada (Turner) Division of Infectious Diseases, Duke University Medical Center, Durham, NC, United States (Paynter, Klaic) School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia (Sullivan) Department of Infectious Diseases, School of Clinical Medicine, St George Hospital, UNSW Medicine and Health, NSW, Kogarah, Australia (Masoum) Department of Pharmacy and Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia (Rawlins) Department of Pharmacy, Fiona Stanley Hospital, Perth, WA, Australia (Mackay) Department of Pharmacy, Albury Wodonga Health, Albury, NSW, Australia (Smith) Department of Infectious Diseases, Western Health, Footscray, VIC, Australia (Kilfoyle) Pharmacy Department, Sunshine Coast University Hospital, QLD, Australia (Kilfoyle) Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, QLD, Australia (Forster) Department of Infectious Diseases, Eastern Health, Box Hill, VIC, Australia (Rose, Lambros) Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (Cowan) Internal Medical Services, Grampians Health Service, Ballarat, VIC, Australia (Alcorn) Department of Infectious Diseases, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia (Alcorn) School of Medicine, Griffith University, Gold Coast, QLD, Australia (Brischetto) Infectious Diseases Unit, Redcliffe Hospital, Brisbane, QLD, Australia (Mahony) Infectious Diseases Unit, Bendigo Health, Bendigo, VIC, Australia (Mahony) Department of Infectious Diseases and Immunology, Austin Health, Heidelberg, VIC, Australia (Redmond) Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia (Redmond) Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, Australia (Redmond) School of Medicine, University of Queensland, Brisbane, QLD, Australia (Chakravorty) Infectious Diseases and General Medicine, St John of God Subiaco, Perth, WA, Australia (Meher-Homji) Department of Medicine, Latrobe Regional Health, Traralgon, VIC, Australia (Meher-Homji) School of Rural Health, Monash University, VIC, Australia (Yuson) Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, SA, Australia (Crawford) Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, NSW, Australia (Crawford) School of Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia (Weeks) Pharmacy Department, Barwon Health, Geelong, VIC, Australia (Ponnampalavanar) Infectious Disease Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur50603, Malaysia (Ponnampalavanar) Department of Infection Control, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia (Katelaris) Immunology/Allergy Unit, Department of Medicine, Campbelltown Hospital and Western Sydney University, Sydney, NSW, Australia (Tran) Department of Pharmacy, Campbelltown Hospital, Sydney, NSW, Australia (O'Hern) Department of Infectious Diseases, Launceston General Hospital, Launceston, TAS, Australia (Godsell) Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Melbourne, VIC, Australia (Peel) Department of Infectious Diseases, Alfred Hospital and School of Translational Medicine, Monash University, Melbourne, VIC, Australia (Sandaradura) Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia (Sandaradura) Sydney Infectious Diseases Institute, University of Sydney, Sydney, NSW, Australia (Sandaradura) Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, NSW, Australia (New) Department of Infectious Diseases, Armadale Health Service, Perth, WA, Australia (Holland) Department of Infectious Diseases, Ipswich Hospital, Ipswich, QLD, Australia (Holland) Metro North Public Health Unit, Windsor, QLD, Australia (Holland) School of Public Health, University of Queensland, Herston, QLD, Australia (Coghill) Department of Infectious Diseases, Lismore Base Hospital, Lismore, NSW, Australia (Hand) Pharmacy Department, Mildura Base Public Hospital, Mildura, VIC, Australia (Williams) Department of Infectious Diseases, Orange Health Service, Orange, NSW, Australia (Williams) School of Rural Health, Charles Sturt University, Orange, NSW, Australia (Bishop) Development and Improvement, East Grampians Health Service, Ararat, Victoria, Australia (Lambros) Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia (Lambros) National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (Lambros) Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia (Ierano) Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, VIC, Australia (Roberts) University of Queensland Centre for Clinical Research, Faculty of Health Medicine and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia (Roberts) Herston Infectious Diseases Institute, Metro North Health, Brisbane, QLD, Australia (Roberts) Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia |
Issue Date: | 9-Apr-2026 | Copyright year: | 2026 | Place of publication: | United States | Publication information: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. (no pagination), 2026. Date of Publication: 01 Apr 2026. | Journal: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Abstract: | BACKGROUND: Approximately 10% of hospitalized patients globally report a penicillin allergy, leading to inappropriate antibiotic prescribing and inferior healthcare outcomes. Evidence supporting the effectiveness and widespread implementation of inpatient penicillin direct oral challenge (DOC) is limited. METHOD(S): A prospective, multicenter, international type 2 hybrid effectiveness-implementation study was conducted in 40 hospitals across 8 countries between November 2022 and May 2025. Adult inpatients with a penicillin allergy underwent assessment using a digital penicillin allergy toolkit (National Antibiotic Allergy Network [NAAN] App). According to site clinical practice, participants received penicillin DOC (effectiveness intervention) or assessment only. Participating sites received bimonthly audit and feedback at least 3 months after site activation (implementation strategy). Observational data were used to emulate a target trial to examine secondary effectiveness outcomes, including antibiotic prescribing at 90 days in DOC versus non-DOC participants. The primary implementation outcome was adoption of the NAAN App within 6 months of site activation. RESULT(S): Among 5121 participants assessed, 1573 (30.7%) underwent DOC, of which 1502 (95.5%) were delabeled. Of 71 (4.5%) participants with a positive DOC, 6 (0.4%) had a serious adverse event. Of 1852 inpatients in the target trial analysis, 892 underwent DOC and 960 underwent assessment only. Participants who underwent DOC were more likely to be prescribed penicillin (risk ratio [RR], 13.25 [95% confidence interval {CI}, 7.82-22.46]), and less likely to be prescribed World Health Organization (WHO) "Watch" or "Reserve" antibiotics (RR, 0.73 [95% CI, .60-.89]) at 90 days post evaluation. Within 6 months of site activation, 77 clinicians adopted the NAAN App. CONCLUSION(S): Multidisciplinary adoption of inpatient penicillin DOC was safe and significantly improved penicillin prescribing and reduced use of WHO restricted antibiotics.Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. | DOI: | https://dx.doi.org/10.1093/cid/ciag082 | PubMed URL: | 41921035 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/58093 | Type: | Article In Press |
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