Can meropenem be administered to patients with hypersensitivity to penicillin (antibiotic)?

From the Guidelines

Meropenem can be given to patients with penicillin allergies, as the risk of cross-reactivity is low, according to the most recent and highest quality study 1. When considering the administration of meropenem to patients with penicillin allergies, it is essential to weigh the potential benefits against the risks. The study by R. Wijnakker et al. 1 suggests that any carbapenem, including meropenem, can be used in patients with suspected immediate-type allergy to cephalosporins, irrespective of severity or time since the index reaction. This recommendation is based on a weak recommendation with low quality of evidence; however, it is the most recent and highest quality study available.

Key points to consider:

• The cross-reactivity between penicillins and carbapenems is low due to differences in side chain structure 1.
• Patients with mild penicillin allergies, such as rash, can generally receive meropenem safely.
• For patients with severe penicillin allergies involving anaphylaxis or other life-threatening reactions, a careful risk-benefit assessment should be made, and if meropenem is deemed necessary, consider administering the first dose in a monitored setting where emergency treatment is available.
• The typical adult dosage of meropenem is 500 mg to 1 gram IV every 8 hours, with adjustments needed for renal impairment.

It is crucial to note that while the evidence suggests that meropenem can be given to patients with penicillin allergies, caution is still warranted, and individual patient factors should be taken into account. The study by R. Wijnakker et al. 1 provides the most recent and highest quality guidance on this topic, and its recommendations should be prioritized in clinical decision-making.

From the FDA Drug Label

Serious and occasionally fatal hypersensitivity (anaphylactic) reactions have been reported in patients receiving therapy with β-lactams. These reactions are more likely to occur in individuals with a history of sensitivity to multiple allergens There have been reports of individuals with a history of penicillin hypersensitivity who have experienced severe hypersensitivity reactions when treated with another β-lactam. Meropenem for injection is contraindicated in patients with known hypersensitivity to any component of this product or to other drugs in the same class or in patients who have demonstrated anaphylactic reactions to beta(β)-lactams.

Meropenem Administration in Patients with Penicillin Allergies

• Meropenem is a β-lactam antibiotic, and patients with a history of penicillin hypersensitivity may be at risk of severe hypersensitivity reactions.
• The FDA drug label recommends inquiring about previous hypersensitivity reactions to penicillins, cephalosporins, other β-lactams, and other allergens before initiating therapy with meropenem.
• If an allergic reaction to meropenem occurs, the drug should be discontinued immediately.
• Caution is advised when administering meropenem to patients with a history of penicillin allergy, and alternative treatments should be considered if possible 2, 2, 2.

From the Research

Meropenem Administration in Patients with Penicillin Allergies

• Meropenem is a widely prescribed beta-lactam antibiotic for hospitalized patients, and its use in patients with penicillin allergies has been evaluated in several studies 3, 4, 5, 6.
• A study published in 2023 found that a bedside meropenem allergy assessment in hospitalized patients labeled with a 'penicillin allergy' who require a broad-spectrum antibiotic is a safe and effective procedure, with 96.4% of patients tolerating the diagnostic workups 3.
• Another study published in 2008 found that meropenem can be safely given to patients with known or unknown allergic reactions to penicillin, including those with anaphylactic reactions, without penicillin skin testing 4.
• The rate of cross-reactivity between penicillins and meropenem has been found to be low, with one study reporting a rate of 0.9% 5.
• A review published in 2019 noted that many patients report allergies to beta-lactam antibiotics, but few have clinically significant reactions, and evaluation of penicillin allergy before deciding not to use penicillin or other beta-lactam antibiotics is an important tool for antimicrobial stewardship 7.
• The use of carbapenems, including meropenem, in patients with a history of penicillin allergy has been found to be safe in several studies, with no significant difference in the incidence of hypersensitivity reactions compared to patients without penicillin allergy 6.

Key Findings

• Meropenem can be safely administered to patients with penicillin allergies, with a low rate of cross-reactivity 3, 4, 5.
• Bedside meropenem allergy assessment is a safe and effective procedure for hospitalized patients with penicillin allergies who require broad-spectrum antibiotics 3.
• Evaluation of penicillin allergy is important for antimicrobial stewardship, and many patients who report penicillin allergies may not have clinically significant reactions 7.
• The use of carbapenems, including meropenem, in patients with penicillin allergies may be reasonable if caution is exercised 6.