Верификация аллергии на пенициллины в акушерстве как инструмент рациональной антибиотикотерапии

Аллергия на пенициллины является одной из наиболее часто регистрируемых лекарственных реакций у беременных, однако в большинстве случаев данный диагноз устанавливается на основании анамнеза без объективной верификации. В акушерской практике это имеет принципиальное значение, поскольку бета-лактамные антибиотики остаются препаратами первой линии для профилактики и лечения инфекций, включая интранатальную профилактику стрептококка группы B, антибиотикопрофилактику при кесаревом сечении и терапию сифилиса во время беременности. Неподтверждённая аллергия ограничивает применение оптимальных схем лечения, способствует назначению альтернативных препаратов широкого спектра действия и может быть связана с повышением риска инфекционных осложнений. В настоящем обзоре проанализированы современные данные о диагностике аллергии на пенициллины у беременных, включая кожное тестирование, пероральные провокационные пробы и инструменты стратификации риска. Представлены результаты клинических исследований, демонстрирующие высокую частоту снятия диагноза аллергии и благоприятный профиль безопасности обследования при правильном отборе пациенток. Рассмотрено влияние верификации аллергического анамнеза на структуру антибактериальной терапии и акушерские исходы. Верификация аллергии на пенициллины в рамках дородового наблюдения рассматривается как важный элемент рациональной антибиотикотерапии и антимикробной стратегии в акушерстве. Расширение практики целенаправленной диагностики позволяет повысить частоту назначения препаратов первой линии без ухудшения материнских и неонатальных показателей.

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