Is ertapenem safe to administer in patients with allergies to ciprofloxacin, sulfonamides, vancomycin, and amoxicillin-clavulanate?

From the Guidelines

Ertapenem is likely safe to administer in patients with allergies to ciprofloxacin, sulfonamides, vancomycin, and amoxicillin-clavulanate.

Key Points

• The overall reported incidence of carbapenem allergy is 0.3%-3.7% 1, and cross-reactivity between carbapenems and other beta-lactams is low.
• A systematic review covering 10 studies and 12 case reports found that carbapenem reactions occurred in 4.3% of patients with proven, suspected, or possible IgE-mediated penicillin allergy 1.
• The risk of cross-reactivity to any carbapenem is estimated to be 0.87% (95% CI: 0.32%-2.32%) 1.
• Patients with penicillin or cephalosporin allergy histories can receive carbapenems without prior testing, as long as it is not a severe delayed cutaneous or organ-involved reaction 1.
• The Dutch Working Party on Antibiotic Policy guideline suggests that any carbapenem can be used in patients with suspected immediate-type or non-severe, delayed-type allergy to cephalosporins, irrespective of time since the index reaction 1.

Considerations

• Ertapenem is a carbapenem antibiotic, and its use in patients with allergies to other antibiotics should be guided by the severity and type of the allergic reaction.
• Patients with a history of severe, delayed-type allergy to cephalosporins, monobactams, or carbapenems should avoid all beta-lactam antibiotics, including ertapenem 1.
• The presence of allergies to non-beta-lactam antibiotics, such as ciprofloxacin, sulfonamides, vancomycin, and amoxicillin-clavulanate, does not necessarily preclude the use of ertapenem, as the cross-reactivity between these classes of antibiotics is low.

From the FDA Drug Label

Patients should be advised that allergic reactions, including serious allergic reactions could occur and that serious reactions may require immediate treatment. Advise patients to report any previous hypersensitivity reactions to ertapenem for injection, other beta-lactams or other allergens

The FDA drug label does not provide information on the safety of administering ertapenem in patients with allergies to ciprofloxacin, sulfonamides, vancomycin, and amoxicillin-clavulanate. Allergies to other antibiotics are not explicitly addressed in relation to ertapenem administration.

• Key consideration: The label only mentions hypersensitivity reactions to ertapenem, other beta-lactams, or other allergens, but does not provide specific guidance on allergies to the mentioned antibiotics.
• Clinical decision: Given the lack of direct information, it is uncertain whether ertapenem is safe to administer in patients with these specific allergies. 2 2

From the Research

Ertapenem Safety in Patients with Allergies

• Ertapenem is a carbapenem antibacterial with a broad spectrum of activity against Gram-negative and Gram-positive aerobic and anaerobic bacteria 3.
• The safety of ertapenem in patients with allergies to other antibiotics, such as ciprofloxacin, sulfonamides, vancomycin, and amoxicillin-clavulanate, is not directly addressed in the provided studies.
• However, studies have shown that ertapenem has a low rate of cross-reactivity with other β-lactam antibiotics, such as penicillins and cephalosporins 4, 5.
• A study found that ertapenem was well tolerated in patients with a history of immediate hypersensitivity reactions to β-lactams, with only one patient experiencing a mild reaction 4.
• Ertapenem has been shown to be effective against a wide range of bacterial pathogens, including those commonly associated with complicated skin and skin structure infections, urinary tract infections, and pneumonia 3, 6.

Cross-Reactivity and Tolerability

• The rate of cross-reactivity between ertapenem and other β-lactam antibiotics is low, suggesting that ertapenem may be a safe option for patients with allergies to these antibiotics 4.
• A study found that ertapenem was well tolerated when administered intramuscularly, with a similar safety profile to ceftriaxone 7.
• However, patients with a history of severe allergic reactions to β-lactam antibiotics should undergo skin tests and a graded challenge to assess tolerability before receiving ertapenem 4.

Antibiotic Selection in Allergic Patients

• Clinicians should consider the type and severity of the allergic reaction when selecting an antibiotic for patients with a history of allergy 5.
• Ertapenem may be a suitable option for patients with a history of allergy to other antibiotics, but careful consideration and evaluation of the patient's allergy history and tolerability are necessary 4, 5.