From the Guidelines
Merrem (Meropenem) can be used in patients with a hypersensitivity to penicillin, as the risk of cross-reactivity is low, according to the most recent and highest quality study 1. When considering the use of Merrem in patients with a penicillin allergy, it is essential to assess the severity of the allergy and the current infection.
- Patients with a history of severe delayed cutaneous or organ-involved reactions to penicillin should exercise caution when using Merrem.
- However, for patients with a history of penicillin or cephalosporin allergy, a carbapenem like Merrem may be administered without testing or additional precautions, as stated in the 2022 practice parameter update 1. The overall reported incidence of carbapenem allergy is 0.3%-3.7%, and the risk of cross-reactivity between carbapenems and other beta-lactams is also low, with a systematic review demonstrating a risk of cross-reactivity to any carbapenem as 0.87% (95% CI: 0.32%-2.32%) 1. In certain patients or situations, such as multiple drug allergy or significant patient anxiety, a graded drug challenge might be preferred, but this should be determined on a case-by-case basis, considering the severity of the infection and available alternative antibiotics.
From the FDA Drug Label
5 WARNINGS AND PRECAUTIONS
- 1 Hypersensitivity Reactions 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.
4 CONTRAINDICATIONS
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.
Merrem (Meropenem) should not be used in patients with a hypersensitivity to penicillin, as there is a risk of severe hypersensitivity reactions, including anaphylaxis.
- The drug label warns of the risk of hypersensitivity reactions in patients with a history of sensitivity to multiple allergens, including penicillin.
- It is contraindicated in patients with known hypersensitivity to any component of the product or to other drugs in the same class, including β-lactams [2] [3].
From the Research
Merrem (Meropenem) Use in Patients with Penicillin Hypersensitivity
- Meropenem can be used in patients with a hypersensitivity to penicillin, as several studies have shown a low rate of cross-reactivity between the two antibiotics 4, 5, 6.
- A study published in the Journal of Chemotherapy found that 110 patients with non-anaphylactic and anaphylactic penicillin allergic reactions tolerated meropenem therapy safely without any allergic reactions 4.
- Another study published in the Annals of Internal Medicine found that only 0.9% of patients with IgE-mediated hypersensitivity to penicillins had a positive skin test result to meropenem, and the remaining patients tolerated escalating dose challenges 5.
- A study in children with IgE-mediated hypersensitivity to penicillins also found a low rate of cross-reactivity with meropenem, with only 0.9% of patients displaying a positive intradermal test result 6.
- A recent study published in Allergology International found that a bedside meropenem allergy assessment in hospitalized patients labelled with a penicillin allergy is a safe and effective procedure, with 96.4% of patients tolerating the diagnostic workups 7.
- The available evidence suggests that meropenem can be safely used in patients with a history of penicillin allergy, but caution should be exercised and skin testing may be recommended in some cases 8, 5, 6, 7.