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Brief Communication: Tolerability of Meropenem in Patients with IgE-Mediated Hypersensitivity to Penicillins
- Antonino Romano, MD;
- Marinella Viola, MD;
- Rosa-Maria Guéant-Rodriguez, MD;
- Francesco Gaeta, MD;
- Rocco Valluzzi, MD; and
- Jean-Louis Guéant, MD, PhD
- 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.
Abstract
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.
Article and Author Information
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Grant Support: By the Italian Ministry for University, Scientific and Technological Research (MURST) and the French Ministry for National Education, Research and Technology (MENRT).
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Potential Financial Conflicts of Interest: None disclosed.
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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.
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Current Author Addresses: Drs. Romano, Viola, Gaeta, and Valluzzi: Unità di Allergologia, Complesso Integrato Columbus, Via G. Moscati, 31, 00168 Rome, Italy.
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Drs. Guéant-Rodriguez and Guéant: INSERM U724, Rue de la Forêt de Haye, 54500, Nancy-Vandoeuvre, France.
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Author Contributions: Conception and design: A. Romano, J.-L. Guéant.
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Analysis and interpretation of the data: A. Romano, M. Viola, R.-M. Guéant-Rodriguez, F. Gaeta, R. Valluzzi, J.-L. Guéant.
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Drafting of the article: A. Romano, M. Viola, R.-M. Guéant-Rodriguez, J.-L. Guéant.
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Critical revision of the article for important intellectual content: A. Romano, M. Viola, R.-M. Guéant-Rodriguez, F. Gaeta, R. Valluzzi, J.-L. Guéant.
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Final approval of the article: A. Romano, M. Viola, R.-M. Guéant-Rodriguez, F. Gaeta, R. Valluzzi, J.-L. Guéant.
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Provision of study materials or patients: A. Romano, M. Viola, F. Gaeta, R. Valluzzi.
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Statistical expertise: A. Romano, R.-M. Guéant-Rodriguez, J.-L. Guéant.
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Obtaining of funding: A. Romano, J.-L. Guéant.
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Administrative, technical, or logistic support: A. Romano.
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Collection and assembly of data: A. Romano, J.-L. Guéant.
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