University of Virginia

2026 RECIPIENT

Best Practices in College Health Award — Clinical Services Category

“Direct Oral Challenge (DOC) Program”

Medical college health teams at the University of Virginia and Vanderbilt University launched Direct Oral Challenge (DOC) programs to evaluate reported amoxicillin and penicillin allergies in 2025 and 2023, respectively. Their early success demonstrates that DOC is both feasible and effective in the college health setting, providing a practical model for institutions worldwide.

Although 10% of patients in the United States report a penicillin allergy, only 1–8% represent true hypersensitivity. Historically, allergists have been the primary providers of drug allergy
evaluation. However, recent clinical guidelines encourage outpatient primary care settings to adopt protocols for low-risk amoxicillin DOC. Accurate de-labeling enables clinicians to use the
most appropriate—and often narrower spectrum—antibiotic, improving care for college students and supporting broader antimicrobial stewardship efforts. The DOC initiatives at UVA and Vanderbilt offer real world examples from both large and mid-sized universities. By sharing their experiences, these teams aim to empower other college health centers to implement similar
programs. Conducting DOC directly within student health streamlines access, reduces the need for specialty referrals, and may lower costs for students. Ultimately, integrating DOC for penicillin and amoxicillin allergies enhances the standard of care in college health and strengthens responsible antibiotic prescribing practices.