ALLERGIC CROSS-SENSITIVITY BETWEEN PENICILLIN AND CARBAPENEM ANTIBIOTICS
Erica D Greanya and Doson Chua

OBJECTIVE: To review the literature evaluating the cross-hypersensitivity between carbapenem and penicillin antibiotics.

DATA SOURCES: Primary literature was accessed through MEDLINE (1980-June 2004), EMBASE (1980-December 2004), International Pharmaceutical Abstracts, PubMed, and references of reviewed articles. Key search terms were carbapenem, imipenem, meropenem, ertapenem, drug hypersensitivity, and penicillin allergy.

STUDY SELECTION AND DATA EXTRACTION: All articles describing clinical studies involving the use of carbapenem antibiotics in patients allergic to penicillin were reviewed.

DATA SYNTHESIS: Four studies assessed carbapenem hypersensitivity in penicillin-allergic patients. Original estimates deemed the cross-reactivity to be 50% based on skin testing in a small number of patients; however, 3 more recent retrospective analyses indicate the overall incidence to be approximately 10%. The retrospective nature and presence of confounding factors in the more recent studies make it difficult to apply the lower estimates of carbapenem cross-sensitivity to a general patient population. The majority of cross-reactivity reactions reported was the development of a rash or hives.

CONCLUSIONS: With minimal data available, the incidence of allergic reaction to carbapenem antibiotics in patients with self-reported penicillin allergy is likely less than the original skin test-determined estimates of 50%. However, caution should be used in patients with previously reported anaphylactic reactions to penicillin. A detailed allergy history is important in determining the clinical consequences of the potential cross-reactivity of carbapenem antibiotics in penicillin-allergic patients.

J Pharm Technol 2005;21:271-5.