BACKGROUND/AIMS: Antibiotic skin testing is a useful procedure for identifying patients with IgE-mediated hypersensitivity to antibiotics. The procedures, however, have not been standardized, and the testing is performed with diverse protocols in Korean hospitals wards. Thus, we examined the current practice of antibiotic skin testing in Korea. METHODS: We sent questionnaires to 12 allergists working in secondary or tertiary referral hospitals and collected them by e-mail or fax. The questionnaire included items such as the types and concentrations of the tested antibiotics, the methods of antibiotic skin testing, and the interpretation of the results. RESULTS: All hospitals responded to the questionnaire. The antibiotic skin testing protocols were variable, inconsistent, and differed with regard to the type and concentrations of antibiotics, the volume injected, and the interpretation of the results. Moreover, the protocols differed from the commonly recommended procedures in the medical literature. CONCLUSIONS: Standardized guidelines for antibiotic skin testing are needed for the safe and effective use of antibiotics in Korea.
Allergy and Immunology/*statistics & numerical data ; Anti-Bacterial Agents/*adverse effects ; Drug Hypersensitivity/*diagnosis ; *Health Care Surveys ; Humans ; Medical Staff, Hospital/statistics & numerical data ; Professional Practice/statistics & numerical data ; Questionnaires ; Republic of Korea ; Skin Tests/*utilization

BACKGROUND/AIMS: Intranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals. METHODS: We performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013. RESULTS: Annual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%. CONCLUSIONS: Inappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.
Administration, Cutaneous ; Anti-Bacterial Agents/*administration & dosage/adverse effects ; Drug Prescriptions ; Drug Resistance, Multiple, Bacterial ; Drug Utilization Review ; *Hospitals, University ; Humans ; Inappropriate Prescribing/*trends ; Methicillin-Resistant Staphylococcus aureus/*drug effects ; Microbial Sensitivity Tests ; Mupirocin/*administration & dosage/adverse effects ; Ointments ; Practice Patterns, Physicians'/*trends ; Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Staphylococcal Skin Infections/diagnosis/*drug therapy/microbiology ; Time Factors