Penicillin Adverse Drug Reaction (HISTORICAL)

Clinical Pathways promote evidence-based, safe, and high-value patient care by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by a methodical review of available evidence and consensus among committee members.

Clinical Pathway:

• Penicillin Adverse Drug Reaction (HISTORICAL) Algorithm 
• Penicillin Adverse Drug Reaction Clinical Pathway Synopsis (provides care standards employed for this clinical pathway) 

Additional tools associated with this Clinical Pathway: 

• Medication Allergy Status wallet card (available from CMH printing portal – click on PRINTING PORTAL, then search for “Medication Allergy Status”) 
• Education and Referral Information
  • Penicillin: What Is It and How to Check for a Penicillin Allergy
  • Antibiotic Allergy Check: What You Need to Know (referral information)
  • Patient Instructions after Amoxicillin Test Dose

 Inclusion and exclusion criteria: 

• Inclusion: 
  • Patients with reported history of adverse drug reaction (ADR) to penicillin antibiotic (e.g., amoxicillin, amoxicillin/clavulanate, ampicillin, dicloxacillin, nafcillin, oxacillin, penicillin, piperacillin) 
• Exclusion:  
  • Patients with acute symptoms of a reaction (if concern for anaphylaxis, see Anaphylaxis Clinical Pathway) 
  • History of ADR to non-penicillin antibiotics (e.g., cephalosporins)  

Committee members involved in the development: 

• Jennifer McKinsey, MD | Urgent Care | Committee Co-Chair 
• Amanda Nedved, MD | Urgent Care | Committee Co-Chair
• Theodore Barnett, MD | Emergency Medicine| Committee Member 
• Rana El Feghaly, MD, MSCI, CPHQ | Infectious Diseases | Committee Member
• Lauren Estes, BSN, RN | Emergency Department | Committee Member
• Christopher Miller, MD | Allergy, Asthma and Immunology | Committee Member
• Brandi Missel, APRN | Emergency Department | Committee Member
• Maria Newmaster, MD | Pediatric Hospital Medicine Fellow | Committee Member
• Aarti Pandya, MD | Allergy, Asthma and Immunology | Committee Member
• Nakita Raje, MD | Allergy, Asthma and Immunology | Committee Member
• Jamie Sherwood, RN, BSN, CPN, CPST, CBC | Urgent Care | Committee Member
• Viktoriya Stoycheva, MHA, BSN, RN, CPN | Emergency Department | Committee Member 
• Sarah Suppes, PharmD | Clinical Pharmacology and Toxicology | Committee Member
• Jana Wheeler, MSN, RN, NI-BC, CPN | Clinical Practice and Quality | Committee Member
• Annie Wirtz, PharmD, BCPPS | Pharmacy / Medication Safety Coordinator | Committee Member
• Chelsea Wolfe, MD | General Academic Pediatrics | Committee Member 

Patient/Family Committee Member: 

• Sheryl Chadwick, BS | Committee Member 

EBP Committee Members: 

• Kathleen Berg, MD, FAAP | Hospitalist, Evidence Based Practice
• Kori Hess, PharmD | Evidence Based Practice 

Publication dates: 

• Finalized date: 09/2025
• Next expected revision date: 2028 

Concerns with content: 

If you have any questions regarding this content or identify a broken link, please email evidencebasedpractice@cmh.edu.  

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.