Brief communication: tolerability of meropenem in patients with IgE-mediated hypersensitivity to penicillins.
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.


METHODS
Prospective skin testing and antibiotic challenge.


METHODS
Allergy units of 2 Italian medical centers.


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


METHODS
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.


CONCLUSIONS
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.
Romano
Antonino
A
Università Cattolica del Sacro Cuore, Complesso Integrato Columbus, Rome, Italy. antoninoromano@h-columbus.it
Viola
Marinella
M
Guéant-Rodriguez
Rosa-Maria
RM
Gaeta
Francesco
F
Valluzzi
Rocco
R
Guéant
Jean-Louis
JL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D000925:Anticoagulants / Q000627:therapeutic use; D003429:Cross Reactions; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced*; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects*; D011446:Prospective Studies; D012882:Skin Tests; D013845:Thienamycins / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology
D047228:Angiotensin II Type 1 Receptor Blockers; D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D010406:Penicillins; D013845:Thienamycins; D000077731:Meropenem