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.
Infectious Diseases, Huron Hospital, Cleveland Clinic Health System, East Cleveland, OH, USA.
Manica
M
Sodhi
Sandra S
SS
Axtell
Joyce
J
Callahan
Raja
R
Shekar
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