Guidelines for skin testing of β-lactam antimicrobials (2021 edition) released

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1.

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6.

7.

8.

Fourth, the identification of allergic history and the treatment of severe allergic reactions

Collection and screening of allergy history should be carefully inquired and recorded in detail: ①Suspicious drug types; ②Dosing route; ③Time interval between administration and occurrence of suspected allergic reaction; ④Clinical manifestations; ⑤Disposal and outcome; ⑥Treatment physician Make a diagnosis.

Attention should be paid to identify whether the "allergic reaction" reported by the patient is a non-allergic adverse drug reaction.

The rescue of severe allergic reactions must race against time.

Treatment measures for severe allergic reactions include:

① Stop the allergy-causing drugs immediately, change the infusion bottle and the infusion set for the intravenous drug users, and closely monitor the heart rate, blood pressure, respiration and blood oxygen saturation during the treatment process;

②Adrenaline (1:1000): a single deep intramuscular injection of 0.

③Keep the airway unobstructed, inhale oxygen, if necessary, tracheal intubation or tracheotomy, if an artificial airway is established unconditionally, cricothyrocentesis can be performed first in an emergency;

④ Establish intravenous channels (two or more), intravenous infusion of crystalloids to maintain blood pressure (liquid dosage 20 ml/kg, adjust the dose according to the patient's condition), and intravenous dopamine to maintain blood pressure when necessary;

⑤ If you have bronchospasm, you can inhale β2 receptor agonists;

⑥ Antihistamines: such as diphenhydramine 1.
25 mg/kg, maximum amount 50 mg, intramuscular injection;

⑦Glucocorticoids: intravenous methylprednisolone 40 mg/100 ml normal saline, or hydrocortisone sodium succinate 100 mg～200 mg;

⑧ If cardiac arrest occurs during any link, standard CPR should be performed immediately on the spot.
After the patient is out of danger after treatment, he should stay in the hospital for observation for at least 12 hours.

5.
Strategies and measures to improve skin test practice

Health administrative departments at all levels, medical institutions, and related academic organizations should fully understand the significance of standardized beta-lactam antibacterial skin tests for the rational application of antibacterial drugs, and gradually improve beta-lactam antibacterial skin tests based on current reality.

(1) Actively organize medical staff to conduct training on the indications, significance, interpretation of the results of the β-lactam antibacterial skin test, and the prevention and treatment of allergic reactions, and correct the prevention of allergic reactions by relying on the skin test and the indications of the skin test.
Misconceptions and practices.
The nurses engaged in skin test operations are given key training on allergic reaction related theories and skin test operations practice.
Establish allergy departments in medical institutions with conditions to improve the prevention and control of skin tests and allergic reactions.

(2) Health administrative departments at all levels, medical institutions, relevant academic organizations, etc.
, should revise the skin test content in relevant regulations, systems, guidelines, consensus , and professional works based on evidence-based evidence and the spirit of this guideline .
Encourage positive feedback to promote the revision of the contents of the skin test in the manual of β-lactam antibacterial drugs.

(3) Before using cephalosporin antibacterial drugs, there is no need for skin test except for the two specific cases that require skin test as specified in the section "II.
Skin Test Indications" above.

(4) Encourage medical institutions and related academic organizations to investigate the incidence of allergic reactions to penicillin and cephalosporin in my country, and provide evidence-based medical evidence for the best combination of penicillin skin test agents in my country.
Coordinate and promote the development or introduction of PPL and MDM to provide more complete reagent types for penicillin skin tests.

(5) According to the recommendations of the World Health Organization on penicillin skin tests, on the basis of full research and advancement of revision of drug inserts, related documents, and authoritative works: ①Accurately locate the indications for penicillin skin tests, and start with oral penicillin drugs , Gradually cancel the routine penicillin skin test screening ; ② improve the penicillin skin test method.

(6) Medical institutions, relevant academic organizations and medical staff actively carry out the popularization of the knowledge of β-lactam antibacterial drug skin test for the public, and fully communicate with relevant management departments to create a good environment for standardizing the skin test of β-lactam antibacterial drugs .

Comparison of the similarity of the side chains of β-lactam drugs

Remarks: The drugs in the same column have the same or similar side chain structure