Brief Communication: Tolerability of Meropenem in Patients with IgE-Mediated Hypersensitivity to Penicillins

20 February 2007 | Volume 146 Issue 4 | Pages 266-269

Background: Although clinicians avoid giving meropenem to patients with penicillin allergy because of potential cross-reactivity, the rate of cross-reactivity between penicillins and meropenem has not been prospectively determined.

Objective: To assess the tolerability of meropenem in patients with documented penicillin allergy.

Design: Prospective skin testing and antibiotic challenge.

Setting: Allergy units of 2 Italian medical centers.

Patients: 104 consecutive participants with immediate hypersensitivity reactions to penicillins and positive skin test results to at least 1 penicillin reagent.

Measurements: Skin tests to meropenem and, if results were negative, challenges with escalating doses of meropenem.

Results: One participant (0.9% [95% CI, 0.02% to 5.2%]) had a positive intradermal test result to meropenem. The remaining 103 participants with negative skin test results to meropenem tolerated escalating dose challenges.

Limitation: Challenges were not followed by therapeutic courses.

Conclusions: These data indicate a low rate of cross-reactivity between penicillins and meropenem. Therefore, the practice of avoiding meropenem therapy in penicillin-allergic patients should be reconsidered. In patients who especially require meropenem treatment, the authors recommend pretreatment skin tests because negative results indicate tolerability.

Editors' Notes Context Frequent cross-reactions between penicillins and imipenem, the prototype carbopenem, may discourage use of other carbopenems in patients with a history of penicillin allergy. Contribution The authors performed skin tests with penicillins and meropenem in 104 patients with a history of immediate reaction to penicillins. All patients had positive skin test results to at least 1 penicillin, while only 1 patient had a positive skin test result with meropenem (prevalence, 0.9% [95% CI, 0.02% to 5.2%]). All 103 patients with a negative meropenem skin test had a negative intravenous meropenem challenge. Caution The patients did not receive a full therapeutic course of meropenem. Implications Allergy to meropenem is uncommon in penicillin-allergic patients. —The Editors

 

Author and Article Information

From Università Cattolica del Sacro Cuore, Complesso Integrato Columbus, Rome, Italy; Istituto di Ricovero e Cura a Carattere Scientifico, Oasi Maria Santissima, Troina, Italy; and Institut National de la Santé et de la Recherche Médicale and Centre Hospitalier Universitaire de Nancy-Brabois, Vandoeuvre, France.

Grant Support: By the Italian Ministry for University, Scientific and Technological Research (MURST) and the French Ministry for National Education, Research and Technology (MENRT).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Antonino Romano, MD, Unità di Allergologia, Complesso Integrato Columbus, Via G. Moscati, 31, 00168 Rome, Italy; e-mail, antoninoromano{at}h-columbus.it.

Current Author Addresses: Drs. Romano, Viola, Gaeta, and Valluzzi: Unità di Allergologia, Complesso Integrato Columbus, Via G. Moscati, 31, 00168 Rome, Italy.

Drs. Guéant-Rodriguez and Guéant: INSERM U724, Rue de la Forêt de Haye, 54500, Nancy-Vandoeuvre, France.

Author Contributions: Conception and design: A. Romano, J.-L. Guéant.

Analysis and interpretation of the data: A. Romano, M. Viola, R.-M. Guéant-Rodriguez, F. Gaeta, R. Valluzzi, J.-L. Guéant.

Drafting of the article: A. Romano, M. Viola, R.-M. Guéant-Rodriguez, J.-L. Guéant.

Critical revision of the article for important intellectual content: A. Romano, M. Viola, R.-M. Guéant-Rodriguez, F. Gaeta, R. Valluzzi, J.-L. Guéant.

Final approval of the article: A. Romano, M. Viola, R.-M. Guéant-Rodriguez, F. Gaeta, R. Valluzzi, J.-L. Guéant.

Provision of study materials or patients: A. Romano, M. Viola, F. Gaeta, R. Valluzzi.

Statistical expertise: A. Romano, R.-M. Guéant-Rodriguez, J.-L. Guéant.

Obtaining of funding: A. Romano, J.-L. Guéant.

Administrative, technical, or logistic support: A. Romano.

Collection and assembly of data: A. Romano, J.-L. Guéant.