Penicillin Allergy Delabelling — RACP Adult Medicine MCQ
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Correct answer: B — Treat with moxifloxacin
Penicillin allergy is over-reported; >90% of patients labelled penicillin-allergic can safely receive penicillin after formal testing. Australian antimicrobial stewardship guidelines strongly recommend penicillin allergy delabelling. A distant childhood rash with unclear details is very unlikely to represent true IgE-mediated allergy. Formal assessment (skin testing ± oral challenge) should be performed when feasible. In the acute setting, many 'penicillin-allergic' patients can safely receive cephalosporins (<2% cross-reactivity with late-generation cephalosporins).
Reference: eTG – 2025 – Antibiotic Guidelines; ACSQHC – 2024 – Antimicrobial Stewardship; ASCIA – 2024 – Drug Allergy