Systematic Review of Professional Liability when Prescribing Β-Lactams for Patients with a Known Penicillin Allergy

OBJECTIVE To describe medical negligence and malpractice cases in which a patient with a known penicillin allergy received a beta-lactam and experienced an adverse reaction related to the beta-lactam. DATA SOURCES Lexis-Nexus, Westlaw, and Google Scholar were searched. STUDY SELECTIONS Medical negligence and malpractice cases were eligible for inclusion if they met the following criteria: the plaintiff had a known penicillin allergy, received a beta-lactam, and experienced an adverse event. All United States federal and state cases were eligible. RESULTS Twenty-seven unique cases met inclusion criteria. Eighteen cases involved the receipt of a penicillin-based antibiotic; of these cases with a known legal outcome, the plaintiff (patient or representative) prevailed or settled in three cases and defendants (providers) prevailed in seven cases. Seven cases involved the receipt of a cephalosporin; of these cases with a known legal outcome, the plaintiff settled with physicians prior to trial in one case and defendants prevailed in three cases. Two cases involved the receipt of a carbapenem. Defendants prevailed in one case and the legal outcome of the other case is unknown. In cases where the defense successfully moved for summary judgment, judges cited a lack of scientific evidence demonstrating a cephalosporin or carbapenem was contraindicated for a patient with a penicillin allergy. CONCLUSION The cases with published legal outcomes found limited professional liability for clinicians who prescribed either cephalosporins or carbapenems to a patient with a known penicillin allergy. These results may decrease the litigation fears of providers and risk managers within healthcare systems.