Direct Oral Challenge for Penicillin Allergy: A Hospital Implementation Evaluation Via the International Network of Antibiotic Allergy Nations (iNAAN) Study

Abstract In this international, multicenter prospective study, implementing penicillin direct oral challenge (DOC) using a digital toolkit was acceptable, feasible, and sustainable. Audit and feedback increased activity, particularly among pharmacists. Safety was maintained across heterogeneous DOC protocols, validating a pragmatic, scalable approach that supports local adaptation.