Is it safe to use carbapenems in patients with a history of allergy to penicillin?
OBJECTIVE
The purpose of this retrospective study was to ascertain the clinical safety of administering carbapenems, namely imipenem/cilastatin and meropenem, in patients with a history of penicillin allergy compared with administering carbapenems in patients with no reported penicillin allergy. Carbapenems are similar in chemical structure to the penicillins and therefore are associated with a risk for allergic cross-hypersensitivity. Carbapenems are commonly avoided in patients with a reported penicillin allergy on the basis of a potential cross-hypersensitivity with penicillin, however, very few studies have been conducted describing the incidence of cross-hypersensitivity between penicillin and carbapenems.


METHODS
A retrospective review was conducted in a total of 266 patients who were administered either imipenem/cilastatin or meropenem. The patients were admitted to the Cleveland Clinic Health System--Eastern Region Hospitals during the years 2001 and 2002.


RESULTS
Fifteen of the 163 patients (9.2%) with reported penicillin allergy developed a hypersensitivity reaction to meropenem or imipenem/cilastatin whereas 3.9% of the 103 patients without penicillin allergy developed a hypersensitivity reaction to meropenem or imipenem/cilastatin. These results are not statistically significant.


CONCLUSIONS
Based on this study and other similar studies, the true incidence of cross-hypersensitivity reactions between penicillin and carbapenems may be lower than previously reported. Carbapenem use may be reasonable for penicillin allergic patients if caution is exercised.
Sodhi
Manica
M
Infectious Diseases, Huron Hospital, Cleveland Clinic Health System, East Cleveland, OH, USA.
Axtell
Sandra S
SS
Callahan
Joyce
J
Shekar
Raja
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D015780:Carbapenems / Q000009:adverse effects* / Q000627:therapeutic use*; D015377:Cilastatin / Q000009:adverse effects / Q000627:therapeutic use; D000077728:Cilastatin, Imipenem Drug Combination; D003429:Cross Reactions; D004338:Drug Combinations; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015378:Imipenem / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects*; D012189:Retrospective Studies; D013845:Thienamycins / Q000009:adverse effects / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015780:Carbapenems; D004338:Drug Combinations; D010406:Penicillins; D013845:Thienamycins; D015377:Cilastatin; D015378:Imipenem; D000077728:Cilastatin, Imipenem Drug Combination; D000077731:Meropenem