JAC Advance Access originally published online on October 14, 2004
Journal of Antimicrobial Chemotherapy 2004 54(6):1155-1157; doi:10.1093/jac/dkh454
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JAC vol.54 no.6 © The British Society for Antimicrobial Chemotherapy 2004; all rights reserved
Is it safe to use carbapenems in patients with a history of allergy to penicillin?
1 Infectious Diseases, Huron Hospital — Cleveland Clinic Health System, East Cleveland, OH; 2 Pharmacy, Hillcrest Hospital — Cleveland Clinic Health System, Mayfield Heights, OH, USA
* Corresponding author. Tel: +1-440-312-4396; Fax: +1-440-312-7104; Email: saxtell{at}cchseast.org
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.
Keywords: imipenem/cilastatin , meropenem , hypersensitivity
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