Questionable history of immediate-type hypersensitivity to penicillin in staphylococcal endocarditis: Treatment based on skin-test results versus empirical alternative treatment - A decision analysis
Questionable history of immediate-type hypersensitivity to penicillin in staphylococcal endocarditis: Treatment based on skin-test results versus empirical alternative treatment - A decision analysis
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DOI：
10.1086/313435
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发表时间：
1999-11-01
影响因子：
11.8
通讯作者：
Phillips, P
中科院分区：
文献类型：
--
作者：
Dodek, P;Phillips, P
大约10%的人声称对青霉素过敏，但只有10%-30%的人对青霉素皮肤试验有IgE介导的反应。青霉素的替代品可能效果较差，毒性更强，而且更昂贵。因此，我们使用决策分析来计算最大预期效用和最小成本的皮肤测试或没有皮肤测试的患者，这些患者患有心内膜炎，由于金黄色葡萄球菌对氯唑西林敏感，并且对青霉素有可疑的速发型超敏反应史。我们使用已知的中间结果概率、实际成本和计量效用，并包括单向敏感性分析。无论效用、成本还是平均成本效用是关注的结果，在大多数情况下，皮肤测试都比没有皮肤测试更受欢迎。患有心内膜炎的患者由于S。对氯唑西林敏感的金黄色葡萄球菌，以及对青霉素有可疑的速发型超敏反应史的患者，在开始抗生素治疗前应进行皮试。
Approximately 10% of the population claim to be allergic to penicillins, but only similar to 10%-30% of these have IgE-mediated reactions to penicillin skin tests. Alternatives to penicillins may be less effective, more toxic, and more expensive. Therefore, We used decision analysis to calculate maximum expected utility and minimum cost for skin-testing or not skin-testing patients who have endocarditis due to Staphylococcus aureus that is susceptible to cloxacillin and who have a questionable history of immediate-type hypersensitivity to penicillin. We used known probabilities of intermediate outcomes, actual costs, and measured utilities and included one-way sensitivity analysis. Whether utility, cost, or average cost-utility was the outcome of interest, skin-testing was preferred to no skin-testing in most conditions. Patients who have endocarditis due to S. aureus that is susceptible to cloxacillin and who also have a questionable history of immediate-type hypersensitivity to penicillin should be skin-tested before starting antibiotic therapy.