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![]() ![]() A total of 10 652 014 antibiotic courses were administered or dispensed, divided approximately evenly between the period before and after removal of the warning. Results Of the 4 206 480 patients who met all inclusion criteria, 2 465 849 (58.6%) were women the mean (SD) age was 40.5 (23.2) years. Regression models were used to examine adverse events. Temporal changes in use rates were controlled for by comparing changes in cephalosporin use among patients with or without a penicillin allergy at the site that removed the warning and among patients at a comparison site that retained the warning. A multinomial logistic regression model was used to examine the change in rates of cephalosporin use before and after an EHR penicillin allergy alert was removed in 1 of the study regions. Main Outcomes and Measures Probability that an antibiotic course was a cephalosporin. Interventions or Exposures Oral or parenteral antibiotics dispensed or administered after removal of an EHR alert to avoid cephalosporin use in patients with a recorded penicillin allergy. Of 4 398 792 patients, 4 206 480 met the eligibility criteria: enrollment in the health system during antibiotic use, availability of complete demographic data, and use of antibiotics outside of the washout period. Objective To examine whether removal of a default alert in the EHR to avoid cephalosporin use in patients with penicillin allergies is associated with changes in cephalosporin dispensing or administration in these patients.ĭesign, Setting, and Participants This retrospective cohort study of a natural experiment included data on patients who had received antibiotic treatment in the hospital or outpatient setting in 2 regions of a large, integrated health system in California from January 1, 2017, to December 31, 2018. ![]() Importance Electronic health records (EHRs) often include default alerts that can influence physician selection of antibiotics, which in turn may be associated with a suboptimal choice of agents and increased antibiotic resistance. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Ratios of ratios of odds ratios for change in cephalosporin use for patients with penicillin allergies from sensitivity analyses Crude rates of new infections for patients with parenteral courses of antibioticsĮTable 20. Crude rates of new infections per 1,000 person yearsĮTable 19. Crude rate of hospital days per person yearĮTable 18. Crude and standardized mortality rates by penicillin allergy status and regionĮTable 17. Odds ratios of antibiotic treatment failure within 30 days of a course of monotherapyĮTable 16. Crude odds ratios of antibiotic treatment failure within 30 days of a course of monotherapyĮTable 15. Odds ratios of new allergy within 30 daysĮTable 14. Fraction of oral and parenteral courses with a new allergy within 30 daysĮTable 13. Fraction of courses with a new allergy within 30 daysĮTable 12. Ratios of ratios of odds ratios for changes in parenteral antibiotic use for patients with penicillin allergiesĮTable 11. Ratios of ratios of odds ratios for changes in oral antibiotic use for patients with penicillin allergiesĮTable 10. Ratios of ratios of odds ratios for changes in antibiotic use for patients with penicillin allergiesĮTable 9. Change in cephalosporin use by generation (all courses)ĮTable 8. ![]() Generation of cephalosporin courses in the analysisĮTable 7. Patterns of antibiotic use, by category, before and after warning was removed in the intervention site, by penicillin allergy status and region, for oral and parenteral courses separatelyĮTable 6. ![]() Descriptive statistics for courses in the analysisĮTable 5. Definitions and modeling strategies for secondary outcomesĮTable 4. Classification of cephalosporin antibiotics by generationĮTable 3. ![]()
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