UMMS Affiliation

Division of Epidemiology, Department of Population and Quantitative Health Sciences

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Document Type



Allergy and Immunology | Health Services Administration | Immune System Diseases | International Public Health | Medical Microbiology | Public Health Education and Promotion


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.


health education and promotion, health systems, medical microbiology, public health, Inaccurate penicillin allergy labels, antimicrobial resistance, drug allergy labelling

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Copyright © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

DOI of Published Version



Krishna MT, Vedanthan PK, Vedanthan R, El Shabrawy RM, Madhan R, Nguyen HL, Kudagammana T, Williams I, Karmacharya B, Hariharan S, Krishnamurthy K, Sumantri S, Elliott R, Mahesh PA, Marriott JF. Is spurious penicillin allergy a major public health concern only in high-income countries? BMJ Glob Health. 2021 May;6(5):e005437. doi: 10.1136/bmjgh-2021-005437. PMID: 34016579; PMCID: PMC8141433. Link to article on publisher's site

Journal/Book/Conference Title

BMJ global health

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.