Is it safe to use carbapenems in patients with a history of allergy to penicillin?

Abstract

OBJECTIVES:

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.

• Authors: Manica Sodhi, Sandra S Axtell, Joyce Callahan, Raja Shekar
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 54 Issue 6 Pg. 1155-7 (Dec 2004) ISSN: 0305-7453 [Print] England
• PMID: 15486083 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Carbapenems
• Drug Combinations
• Penicillins
• Thienamycins
• Cilastatin
• Imipenem
• Cilastatin, Imipenem Drug Combination
• Meropenem

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Carbapenems (adverse effects, therapeutic use)
• Cilastatin (adverse effects, therapeutic use)
• Cilastatin, Imipenem Drug Combination
• Cross Reactions
• Drug Combinations
• Drug Hypersensitivity (epidemiology, etiology)
• Female
• Humans
• Imipenem (adverse effects, therapeutic use)
• Incidence
• Male
• Meropenem
• Middle Aged
• Penicillins (adverse effects)
• Retrospective Studies
• Thienamycins (adverse effects, therapeutic use)