Your July 11 editorial “A threat to modern medicine,” on the growing antibiotic resistance, is a call to action. Antibiotic development alone is not the solution, especially since evaluating new drugs, even if available, takes years.
One reason broad-spectrum antibiotics (e.g., quinolones) are widely used is that many patients report allergy histories to narrow-spectrum drugs such as penicillin, which have a lower potential for promoting resistance. Clinicians have a low threshold for diagnosing penicillin allergy, and this often becomes a lifelong label. Allergy research has clearly shown that more than 80 percent of patients with histories of documented penicillin allergy lose their allergic sensitivity over time and can safely receive penicillin if their allergy skin tests are negative.
Validated skin testing is available from allergy specialists and other physicians. Unfortunately this is underused, because primary-care and infectious-disease physicians are not well informed about the potential that skin testing has to reverse the “penicillin allergy” diagnosis for a large majority of patients. If we can remove the “penicillin allergy” label, we can replace the antibiotics that promote antimicrobial resistance with effective and safe penicillin for common infections.
Increased penicillin skin testing is an important and often-neglected remedy in the continuing battle against antibiotic resistance.
Jonathan M. Zenilman, Baltimore
The writer is chief of infectious diseases division at Johns Hopkins Bayview Medical Center.