Effectiveness, barriers, and facilitating factors of strategies for active delabeling of patients with penicillin allergy labels: a systematic review protocol.

IntroductionUp to 15 % of adult patients in the clinical setting report to be allergic to penicillin. However, in most cases penicillin allergy is not confirmed. Due to the negative aspects associated with erroneous penicillin allergy, the implementation of active delabeling processes for penicillin allergy is an important part of antibiotic stewardship programs. Depending on the clinical setting, different factors need to be considered during implementation. This review examines the effectiveness of different delabeling interventions and summarizes components and structures that facilitate, support, or constrain structured penicillin allergy delabeling. Methods and analysisThis review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The Databases MEDLINE (via PubMed), EMBASE, and Cochrane Library were searched for studies reporting on any intervention to identify, assess, or rule out erroneous penicillin allergy. Study design, intervention type, professional groups involved, effectiveness, limitations, barriers, facilitating factors, clinical setting, and associated regulatory factors will be extracted and analyzed. Two independent reviewers will perform the screening process and data extraction. Discordant decisions will be resolved through review by a third reviewer. Bias assessment of the individual studies will be performed using the Newcastle Ottawa Scale. Ethics and disseminationBecause individual patient-related data is not analyzed, an ethical approval is not required. The review will be published in a peer-reviewed scientific journal. STRENGHTS AND LIMITATIONS OF THIS STUDY- The systematic review will adhere to the PRISMA guidelines. - A wide search strategy is used and the search will be conducted on three major databases. - The search is focused on studies reporting on facilitators and barriers for implementation as well as effectiveness of penicillin allergy delabeling interventions. - Data extraction will be performed using an established second look process. - Risk for bias in the individual studies as well as external validity is assessed using an established checklist (Newcastle Ottawa Scale).