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.

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.