Polypharmacy Guidance: appropriate prescribing, making medicines safe, effective and sustainable 2025 - 2028

Closes 22 Sep 2025

9. Antibiotics and penicillin allergy

Antibiotics

The decision to start or not start antibiotic therapy, requires careful consideration as there are potential side-effects, which may add to the symptom burden at end-of-life.

  • Antibiotics may be indicated to relieve symptoms or potentially cure an infection at the end-of-life.
  • Risks and benefits should be considered including when treatment would require hospitalisation.

 

Penicillin allergy

Approximately 10% of people identify as having a penicillin allergy, however true penicillin allergy is estimated to affect only one percent of the population.

  • It is essential that individuals who have a potentially incorrect penicillin allergy label are fully assessed to confirm if they are truly allergic or not.
  • For people who do not have a true penicillin allergy, it may be possible to consider supervised penicillin allergy de-labelling (PADL) oral challenge. PADL may be undertaken in a hospital setting after careful assessment of risk.
9a. Do you agree or disagree with the recommendations for antibiotic use at the end of life?
9b. Please provide any further comments about our recommendations.
9c. Do you agree or disagree with the recommendations for managing penicillin allergies?
9d. Please provide any further comments about our recommendations.