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In patients with penicillin sensitivity, carbapenems may be viable option
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In patients with a clinical history of immunoglobulin E-mediated hypersensitivity to penicillins or cephalosporins, carbapenems may be a reasonable antibiotic treatment option, according to recent findings.
However, caution is advised, and anaphylaxis management should be available when administering the initial dose, researchers wrote.
In a systematic review, the researchers searched various databases for all published studies pertaining to patients of any age with history of IgE-mediated allergy to penicillins or cephalosporins, who subsequently underwent at least one dose of a carbapenem regimen. Six prospective studies, four retrospective studies and 12 case studies were identified for inclusion in the analysis, with a total of 854 patients.
A reaction was defined as confirmed IgE-mediated if the patient experienced hypotension, wheezing, angioedema, laryngeal edema, hospitalization or death within 4 hours of drug administration. The researchers stratified patients within each study based on proven, suspected or possible IgE-mediated reaction to penicillins, cephalosporins, or both.
The researchers found that among the 838 patients with prior proven, suspected or possible IgE-mediated penicillin reactions, 36 (4.3%; 95% CI, 3.1%-5.9%) experienced some type of suspected hypersensitivity reaction to a carbapenem. There was one proven and 19 possible IgE-mediated reactions (2.4%; 95% CI, 1.6%-3.7%). Among a subset of patients who previously had positive penicillin skin tests (n=295), only one experienced a possible IgE-mediated hypersensitivity reaction (0.3%; 95% CI, 0.06%-1.9%). Among the 12 patients with previous proven, suspected or possible IgE-mediated reactions to a cephalosporin, three (25%) experienced any type of allergic reaction to a carbapenem. These reactions consisted of two non-IgE mediated reactions and one possible IgE-mediated reaction.
According to the researchers, the introduction of a carbapenem in patients with reaction history to either penicillins or cephalosporins should be monitored carefully, possibly through challenge doses.
“One option would be to challenge with a very low dose of the carbapenem, such as 1% of the full dose,” they wrote. “If the patient has no reaction, then 10% of the full dose could be given 1 hour later, followed by the full dose 1 hour later if the patient remains asymptomatic. There are far less data on the cross-reactivity between cephalosporins and carbapenems so again, a protocol with challenge doses should be strongly considered.”
Disclosure: The researchers report no relevant disclosures.
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