Polypharmacy prescribing guidance - draft: consultation

9. Antibiotics and penicillin allergy

Antibiotics

The decision to start or not start antibiotic therapy, requires careful consideration as there are potential side-effects, which may add to the symptom burden at end-of-life.

• Antibiotics may be indicated to relieve symptoms or potentially cure an infection at the end-of-life.
• Risks and benefits should be considered including when treatment would require hospitalisation.

Penicillin allergy

Approximately 10% of people identify as having a penicillin allergy, however true penicillin allergy is estimated to affect only one percent of the population.

• It is essential that individuals who have a potentially incorrect penicillin allergy label are fully assessed to confirm if they are truly allergic or not.
• For people who do not have a true penicillin allergy, it may be possible to consider supervised penicillin allergy de-labelling (PADL) oral challenge. PADL may be undertaken in a hospital setting after careful assessment of risk.

Question 9a

Do you agree or disagree with the recommendations for antibiotic use at the end of life?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 9b

Please provide any further comments about our recommendations.

Question 9c

Do you agree or disagree with the recommendations for managing penicillin allergies?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 9d

Please provide any further comments about our recommendations.