Is spurious penicillin allergy a major public health concern only in high-income countries?

Mamidipudi Thirumala Krishna, Pudupakkam K Vedanthan, Rajesh Vedanthan, Reham Mohamed El Shabrawy, Ramesh Madhan, Hoa L Nguyen, Thushara Kudagammana, Iestyn Williams, Biraj Karmacharya, Seetharaman Hariharan, Kandamaran Krishnamurthy, Stevent Sumantri, Rachel Elliott, Padukudru Anand Mahesh, John F Marriott

Research output: Contribution to journalComment/debatepeer-review


Inaccurate penicillin allergy labels (PALs) are a major public health problem in high-income countries and has been linked to antimicrobial resistance (AMR) and huge healthcare costs.

Data regarding epidemiology of PALs and its potential association with AMR is sparse in low-income countries (LICs), low-middle-income countries (LMICs) and upper-middle-income countries (UMICs).

There are no established drug allergy labelling and delabelling pathways in the majority of the LICs, LMICs and UMICs and addressing these inequities is critical for safe clinical practice and in the global campaign against AMR.

A standardised validated computerised decision support tool might help address these gaps, but understanding local factors including clinical governance, cultural, social, religious and human behaviour will be key to uptake and success of such an intervention.
Original languageEnglish
Article numbere005437
JournalBMJ Global Health
Issue number5
Publication statusPublished - 20 May 2021


  • health education and promotion
  • health systems
  • medical microbiology
  • public health


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