# Penicillin allergy de‐labelling in the critical care unit: Simulations to design an intravenous drug provocation test that mirrors the plasma profile of an enteral challenge

## TL;DR

This paper explores designing an IV penicillin test for critically ill patients to safely remove incorrect penicillin allergy labels.

## Contribution

The study proposes an IV dosing schedule that mimics oral penicillin challenge profiles in non-oral settings.

## Key findings

- Simulations identified an IV infusion protocol matching oral penicillin's plasma profile.
- The proposed method could safely assess penicillin allergy in critically ill patients.
- This approach may improve antibiotic use and patient outcomes in critical care.

## Abstract

The majority of penicillin allergy labels are incorrect and a label of penicillin allergy is associated with worse outcomes and increased use of healthcare services. Penicillin allergy assessment and de‐labelling may be considered in critically ill patients. An oral penicillin challenge is a common component of most penicillin allergy protocols. In critical illness, the enteral route may not be an option and is less reliable due to altered absorption kinetics. In this study, simulations were undertaken to determine an intravenous infusion dosing schedule for critically ill patients that matches the concentration–time profile of an oral penicillin drug provocation test in the general population. These simulations may help clinicians develop procedures for intravenous infusion penicillin drug provocation tests for critically ill patients.