# Nationwide survey on penicillin allergy delabeling among German healthcare professionals: knowledge, attitudes and perceived barriers

## TL;DR

This study surveyed German healthcare professionals about their knowledge and practices regarding penicillin allergy delabeling, finding limited implementation but strong potential for improvement with proper support.

## Contribution

The study provides the first nationwide assessment of penicillin allergy delabeling practices and barriers among non-allergist healthcare professionals in Germany.

## Key findings

- Only 32% of healthcare professionals had performed penicillin allergy delabeling, with limited frequency.
- Lack of time, experience, and guidance were major barriers to delabeling implementation.
- Most professionals expressed interest in delabeling if provided with clear protocols and institutional support.

## Abstract

Penicillin allergy (PA) delabeling optimizes antibiotic prescribing and is a recognized antimicrobial stewardship (AMS) tool. We aimed to characterize current practices and knowledge of PA delabeling in German non-allergist healthcare professionals to define barriers and facilitators for a wider implementation of delabeling strategies.

A nationwide web-based, anonymous survey was distributed to physicians and hospital pharmacists. It covered four domains: demographics, access to AMS, allergy assessment and attitude towards PA delabeling. Responses were analysed using descriptive and inferential statistics.

A total of 504 responses (249 physicians, 255 pharmacists) were analysed. While 86% of respondents were familiar with the concept of delabeling, only 32% had ever performed it, mostly fewer than 6 times in the past year. 12% of physicians regularly took extended allergy histories, and just 2% always used a standardized method. Only ~ 30% of respondents had onsite access to allergy services. Barriers included lack of time, experience and guidance. Pharmacists frequently cited PA management as outside their role. Despite limited experience, 88% of physicians and 71% of pharmacists expressed interest in delabeling if supported by clear algorithms and institutional support.

PA delabeling by non-allergists is of great relevance to physicians and pharmacists in Germany but not routinely integrated in clinical pathways, due to missing guidelines, limited resources and unclear role definitions. However, the results of this study highlight the considerable strong potential for implementing structured delabeling strategies—if they are supported by adequate training, clear protocols and sufficiently resourced antimicrobial stewardship teams.

The online version contains supplementary material available at 10.1007/s15010-026-02731-z.