Management of Penicillin and Beta-Lactam Allergy


Therapeutic Review

  • Early studies evaluating the risk of cross-reactivity between penicillin and carbapenems found rates upwards of 47%
    • However, these studies had poor definitions of allergy and variable methods for determining allergy status
  • A more recent systematic review was completed to collect and combine all published data on pediatric and adult patients reported to have a clinical history of type-1 immediate hypersensitivity (IgE-mediated) to a penicillin and/or cephalosporin who were then given a carbapenem
  • Within the study allergic reactions were classified as proven, suspected or possible IgE-mediated and non-IgE-mediated
  • Overall, for patients with a history of proven, suspected or possible IgE-mediated reaction to a penicillin; 4.3% (36/838) had a suspected hypersensitivity reaction to a carbapenems but only 20 were compatible with an IgE-mediated reaction and only one was considered to be proven
  • The authors concluded that carbapenems would be a reasonable option when antibiotics are required in patients with IgE-mediated reactions to penicillins
  • They advise that clinicians proceed with caution by administering the first dose of carbapenem in a setting where anaphylaxis can be managed and to consider giving via a graduated challenge

If at any stage the patient reacts to carbapenem then the options are to use a carbapenem desensitization protocol or switch to a non-beta-lactam antibiotic