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In set-up: due to open June 2019.


ALABAMA is a randomised controlled trial to evaluate whether the Penicillin allergy assessment pathway (PAAP) intervention is clinically effective in improving patient health outcomes.


Penicillin allergy is a commonly encountered problem for GPs needing to prescribe antibiotics. Penicillins remain first-line therapy for many common infections but are typically avoided in those who have a record of penicillin allergy. These records are often unsubstantiated and therefore potentially unnecessary avoidance of Penicillins continues. About 10% of the UK population think they have penicillin allergy but only 1 in 100 patients are truly allergic. There is increasing evidence that a penicillin allergy record has a negative impact on patient outcomes. Therefore ALABAMA is a timely evaluation with the aim of identifying and correcting those individuals who have ‘false positive’ records of penicillin allergy and assess how this affects patient outcomes and cost effectiveness.


It is a multicentre, two parallel-arm, open label, individually randomised pragmatic trial with a nested-pilot study.


Potential patients benefits: if pen-allergy status is changed, first-line penicillin treatment for many infections can resume.

Potential societal benefits: changes in antimicrobial prescribing/reduced antimicrobial resistance.

Potential NHS benefits: reduced cost from improved outcomes, fewer GP visits, altered antimicrobial use.