Penicillin Allergy Evaluation Pathway in a Community-Based Obstetric Setting: A Quality Improvement Study.

BACKGROUND: The objective of this study was to increase completion of penicillin allergy evaluation among pregnant patients and assess its impact on antibiotic utilization and safety. METHODS: This quality improvement initiative was conducted across Mayo Clinic Health System obstetric departments in southeast Minnesota from September 12, 2023, through February 15, 2025. Pregnant patients with a reported penicillin allergy presenting for prenatal care were included. The intervention consisted of standardized screening, referral, and Allergy and Immunology-led evaluation, including skin testing and oral challenge. The primary outcome was completion of penicillin allergy evaluation. Secondary outcomes included antibiotic utilization and adverse events. Statistical comparisons were performed using χ² or Fisher's exact tests, with significance defined as p < 0.05. RESULTS: Among 120 eligible patients, 56 (46.7%) completed evaluation, 24 (20.0%) had incomplete evaluation, and 40 (33.3%) declined. Of those completing evaluation, 49 (87.5%) were delabeled. β-lactam antibiotic use was significantly higher in the evaluation-complete group compared with the noncompleted group (96.6% vs 77.5%; p = 0.037). Among patients with group B Streptococcus positivity undergoing vaginal delivery, penicillin use was 90.9% in the evaluation-complete group compared with 0.0% in the noncompleted group (p < 0.001). Adverse reactions occurred in 4 patients and were mild and self-limited. CONCLUSION: Implementation of a structured penicillin allergy evaluation pathway in a community-based obstetric setting was feasible, safe, and associated with significant improvements in guideline-concordant antibiotic use.