From the Guidelines
Patients with a penicillin allergy can generally receive meropenem without significant concern for cross-sensitivity, as the overall reported incidence of carbapenem allergy is low, ranging from 0.3% to 4.3% in various studies. The cross-sensitivity between meropenem and penicillin allergy is considered to be low, with a systematic review covering 10 studies and 12 case reports finding that carbapenem reactions occurred in 4.3% of patients with proven, suspected, or possible IgE-mediated penicillin allergy 1. Another systematic review and meta-analysis demonstrated a risk of cross-reactivity to any carbapenem as 0.87% (95% CI: 0.32%-2.32%) 1.
Key points to consider include:
- The low cross-reactivity between carbapenems and other beta-lactams, including penicillins, is due to differences in molecular structure, particularly in the side chains and beta-lactam ring configuration 1.
- Patients with a history of penicillin or cephalosporin allergy can receive a carbapenem without testing or additional precautions, according to a consensus-based statement 1.
- However, caution is still warranted in patients with severe penicillin allergies involving anaphylaxis or other IgE-mediated reactions, and skin testing or graded challenge protocols under medical supervision may be considered in these cases.
- A recent prospective study of 211 patients with skin test–confirmed penicillin allergy demonstrated that all tolerated carbapenems, supporting the use of carbapenems in patients with penicillin allergy 1.
Overall, the current evidence supports the use of meropenem in patients with penicillin allergy, with a low risk of cross-sensitivity, and clinical judgment should be used to evaluate individual patient risk 1.
From the FDA Drug Label
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. Before initiating therapy with Meropenem for injection (I.V.), it is important to inquire about previous hypersensitivity reactions to penicillins, cephalosporins, other β-lactams, and other allergens.
The cross-sensitivity between meropenem and penicillin allergy is a concern, as patients with a history of penicillin hypersensitivity may experience severe hypersensitivity reactions when treated with meropenem, a β-lactam antibiotic.
- Key points:
- Meropenem is contraindicated in patients with known hypersensitivity to any component of this product or to other drugs in the same class.
- Patients with a history of penicillin hypersensitivity are at risk of severe hypersensitivity reactions when treated with meropenem.
- It is essential to inquire about previous hypersensitivity reactions to penicillins, cephalosporins, other β-lactams, and other allergens before initiating therapy with meropenem 2.
From the Research
Cross-Sensitivity between Meropenem and Penicillin Allergy
- The cross-sensitivity between meropenem and penicillin allergy is a significant concern in clinical practice, as patients with a history of penicillin allergy may be at risk of an allergic reaction to meropenem 3, 4.
- However, several studies have investigated the safety of meropenem in patients with a reported penicillin allergy, and the results suggest that the risk of cross-reactivity is low 3, 5, 6.
- A prospective study published in 2008 found that 110 patients with non-anaphylactic and anaphylactic penicillin allergic reactions tolerated prolonged meropenem therapy safely without any allergic reactions 3.
- Another study published in 2004 found that the incidence of cross-hypersensitivity reactions between penicillin and carbapenems, including meropenem, may be lower than previously reported 4.
- A retrospective analysis published in 2023 found that meropenem allergy assessment in admitted patients with a reported history of penicillin allergy is a safe and effective procedure, with only two patients experiencing a non-severe cutaneous reaction 5.
- A study published in 2008 found that children with IgE-mediated hypersensitivity to penicillins had a low rate of cross-reactivity to meropenem, and that prophylactic skin tests can help identify patients who can tolerate meropenem 6.
- Overall, the evidence suggests that meropenem can be safely administered to patients with a history of penicillin allergy, but caution should be exercised and skin tests or challenges may be necessary to assess tolerability 3, 4, 5, 6, 7.
Key Findings
- Low rate of cross-reactivity between meropenem and penicillin allergy 3, 5, 6.
- Meropenem can be safely administered to patients with a history of penicillin allergy, but caution should be exercised 3, 4, 5, 6, 7.
- Skin tests or challenges may be necessary to assess tolerability in patients with a history of penicillin allergy 5, 6, 7.