Verification of Penicillin Allergy in Obstetric Practice as a Tool for Rational Antibiotic Therapy

Penicillin allergy is one of the most frequently reported drug reactions among pregnant women; however, in most cases, the diagnosis is based solely on patient history without objective verification. In obstetric practice, this has substantial clinical implications, as β-lactam antibiotics remain first-line agents for the prevention and treatment of infections, including intrapartum prophylaxis for Group B Streptococcus, antibiotic prophylaxis during cesarean delivery, and treatment of syphilis in pregnancy. An unverified allergy label limits the use of optimal treatment regimens, promotes the prescription of broader-spectrum alternatives, and may be associated with an increased risk of infectious complications. This review analyzes current evidence on the evaluation of penicillin allergy in pregnant patients, including skin testing, direct oral challenges, and risk stratification tools. Clinical studies demonstrate a high rate of penicillin allergy de-labeling and a favorable safety profile of diagnostic procedures when appropriate patient selection is applied. The article also discusses the impact of allergy verification on antibiotic prescribing patterns and obstetric outcomes. Verification of penicillin allergy within routine prenatal care should be considered an essential component of rational antibiotic therapy and antimicrobial stewardship in obstetrics. Expanding targeted diagnostic strategies may increase the use of first-line β-lactam antibiotics without adversely affecting maternal or neonatal outcomes.

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