38. What is penicillin allergy de-labelling (PADL) and why is it important with Prof Phil Howard

Welcome to the latest episode of Talking Meds and the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, talks to Prof Philip Howard about penicillin allergy de-labelling, colloquially known as PADL.

Philip is a leading expert in antimicrobial stewardship, he currently serves as Antimicrobial Resistance (AMR) Regional Antimicrobial Stewardship Lead for NHS England North-East & Yorkshire. He is also a Past President of the British Society of Antimicrobial Chemotherapy, a member of the DHSA advisory group on AMR and healthcare-acquired infections, and supports NICE in developing infectious disease guidance.

He has published widely on antimicrobial stewardship (AMS) and antibiotic shortages, and has delivered AMS education and training globally. Among his many honours, I know he was especially proud to receive an OBE for services to healthcare.

Patients with a recorded penicillin allergy cannot receive many first-line antibiotics and may need second or third-line agents, increasing antimicrobial resistance. Although true penicillin allergy can be life-threatening due to anaphylaxis, 6–8% of the UK population (4–5 million people) carry a label, and up to 95% are inaccurate. Careful penicillin allergy de-labelling (PADL) therefore benefits both individuals and public health.

PrescQIPP resources mentioned in this episode;

• Bulletin 313: Antimicrobial stewardship
• Clinical Masterclass - July 2024 - Antimicrobial Stewardship; NAP for success in AMS
• Antimicrobial stewardship
• NHS Oversight Framework 2025-2026 - ICB performance dashboard: Children prescribed antibiotics in primary care

Other resources mentioned in this episode;

• Summary of antimicrobial prescribing guidance - managing common infections
• Start smart then focus: toolkit summary
• ALABAMA study
• National patient safety alert – harm from incorrect recording of penicillin allergy as penicillamine allergy

A new episode of Talking Meds will be available every other Friday.
If you have feedback or suggestions for future topics and guests please submit them to talkingmeds@prescqipp.info

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email help@prescqipp.info and we’ll aim to sort things out for you.

Find out more about PrescQIPP here