Benefits , harms , and costs Guideline implementation should result in a reduction of cost and related harm of administering antibiotics when not required and a reduction of infection and related morbidities when antibiotics have demonstrated a proven benefit .
Abstract Objective To review the evidence and provide recommendations on antibiotic prophylaxis for gynaecologic procedures .
Outcomes Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in gynaecologic procedures .
Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults.
BACKGROUND A history ( or lack thereof ) of penicillin allergy is known to be unreliable in predicting reactions on subsequent administration of the drug . This study tests the usefulness of four penicillin allergen skin tests in the prediction of IgE-mediated reactions subsequent to administration of penicillin . METHODS Eight centers cooperated in the National Institute of Allergy and Infectious Diseases trial of the predictive value of skin testing with major and minor penicillin derivatives .  Hospitalized adults were tested with a major determinant ( octa-benzylpenicilloyl-ocytalysine ) and a minor determinant mixture and its components ( potassium benzylpenicillin , benzylpenicilloate , and benzylpenicilloyl-N-propylamine ) . Patients then received a therapeutic course of penicillin and were observed , for 48 hours , for adverse reactions compatible with an IgE-mediated immediate or accelerated allergy . RESULTS Among 726 history-positive patients , 566 with negative skin tests received penicillin and only seven ( 1.2 % ) had possibly IgE-mediated reactions . Among 600 history-negative patients , 568 with negative skin tests received penicillin and none had a reaction . Only nine of the 167 positive skin test reactors received a penicillin agent and then usually by cautious incremental dosing . Two ( 22 % ) of these nine patients had reactions compatible with IgE-mediated immediate or accelerated penicillin allergy ; both were positive to the two determinants . CONCLUSIONS These data corroborate previous data about the negative predictive value of negative skin tests to these material s. The reaction rate in skin test-positive patients was significantly higher than in those with negative skin tests , demonstrating the positive predictive value of positive tests to both major and minor determinants . The number of patients positive only to the major determinant or only to the minor determinant mix was too small to draw conclusions about the positive predictive value of either reagent alone
Benefits , harms , and costs Guideline implementation should result in a reduction of cost and related harm of administering antibiotics when not required and a reduction of infection and related morbidities when antibiotics have demonstrated a proven benefit .
Abstract Objective To review the evidence and provide recommendations on antibiotic prophylaxis for gynaecologic procedures .
Outcomes Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in gynaecologic procedures .