The International Network of Antibiotic Allergy Nations (iNAAN): Implementation of Multidisciplinary Penicillin Allergy Delabeling Health Service Programs

Abstract

Aim Penicillin allergy is common and can be addressed with inpatient penicillin allergy delabeling services. However, access to such services and resources is limited. The International Network of Antibiotic Allergy Nations (iNAAN) was established to audit the implementation, safety, antimicrobial prescribing, and health service impacts of multidisciplinary led penicillin allergy delabeling health service programs. Methods The iNAAN study employs a Hybrid Type 2 effectiveness-implementation design, prospectively examining outcomes of a point-of-care validated digital penicillin allergy toolkit within Australian and international health services. Clinical effectiveness outcomes include the proportion of patients with a low-risk penicillin allergy who are delabeled following direct oral challenge (DOC), antimicrobial utilisation pre- and post- testing, and hospital length of stay. Implementation outcomes include adoption by multidisciplinary stakeholders, sustainability, and acceptability of the digital penicillin allergy toolkit. The primary implementation strategy uses digital audit and feedback, with individualised reports detailing clinical effectiveness and implementation outcomes, and health service benchmarking, to aid scaling of penicillin allergy programs. Results From 9th November 2022 to 7th June 2024, 29 Australian and three international health services were enrolled, including in rural regions and low-middle income countries. Multidisciplinary clinicians, including medical practitioners, pharmacists, and nurses, have performed 1603 penicillin allergy assessments and 545 DOCs. Of the DOCs performed, 97% were negative and delabeled, concordant with existing literature. Nil serious adverse events have occurred. Conclusion The iNAAN platform, implementation strategy, and international collaborations provide a mechanism to expand future penicillin and other antibiotic allergy health services research that will inform antimicrobial stewardship and drug allergy policy. Future iNAAN database linkage will enable analysis of penicillin allergy impact on antimicrobial prescribing, antimicrobial resistance, and mortality. Impact iNAAN facilitates implementation of penicillin allergy programs in Australian and international hospitals to improve patient access to antibiotic allergy testing and improve antibiotic prescribing.