118 Chapter 5 Introduction Allergies to antibiotics are among the most commonly reported adverse reactions to medication. Adequate registration of these allergies is essential to prevent rare but potentially life-threatening reactions upon re-exposure. In Dutch primary care, 0.6% to 2.1% of patients have an antibiotic allergy registration in their electronic medical record (EMR) [1, 2). Worldwide higher rates of antibiotic allergy registrations have been reported, ranging up to 25% (3). However, between 80 to 90% of antibiotic allergy registrations in primary care are incorrect (1, 4, 5). Antibiotic allergy registrations are associated with more frequent visits to the doctor, higher healthcare costs and more frequent prescription of second-choice antibiotics (2, 6–8). Importantly, the efficacy and/or toxicity profiles of second-choice antibiotics are generally less favourable compared to the narrow spectrum antibiotics that most often constitute first choice of treatment. The use of broad-spectrum antibiotics also increases risk of Clostridiodes difficile-associated diarrhoea and promotes the emergence of antimicrobial resistance (9). In The Netherlands antibiotic allergies are registered in all healthcare domains, including primary care, hospitals, pharmacies and long-term elderly care facilities. Primary care physicians play a pivotal role in the registration of antibiotic allergies, since in The Netherlands they function as gatekeeper for entry to most other healthcare fields. Ninety percent of antibiotic prescriptions, and the majority of antibiotic allergy registrations, originate in primary care (10). EMRs kept in primary care contain all essential medical data and function as a central medical record for most other healthcare domains. Antibiotic allergies registered in other healthcare domains are subsequently recorded in the patient’s primary care EMR and vice versa, thus facilitating further dissemination of antibiotic allergy registrations from one healthcare setting to the other. The registration of antibiotic allergies transcends primary care practice. Therefore, any effort to tackle this issue should be collaborative and involve all relevant healthcare domains. Although the quality of current antibiotic allergy registration is known to be insufficient (1, 7, 8, 11), detailed insight into the specific aspects of registration that could be improved is lacking. In addition, a better understanding of the determinants of incorrect antibiotic allergy registration and -in particular- the similarities and differences between healthcare domains is needed. This information will be essential to the effective design and implementation of interventions aimed at improving antibiotic allergy registration.
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