Cross-reactivity between carbapenems: Two case reports

Noguerado-Mellado, Blanca; Fernández, Carlos Sánchez; Pineda-Pineda, Rafael; Lezcano, Patricia Martínez; Álvarez-Perea, Alberto; Fernández, Manuel De Barrio

doi:10.1016/j.jaip.2014.06.015

Cited by 13 publications

(13 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…1 There are only three case reports of patients who developed a delayed exanthema to imipenem with good tolerance to meropenem and, conversely, one case of delayed reaction to meropenem with tolerance to imipenem. [2][3][4] Patch tests with carbapenems have a negative predictive value of 100%: in individuals with reported T-cell hypersensitivity to penicillins;negative PT results correlate with a subsequent tolerance to a therapeutic dose of carbapenems. 5 Published reports of a lack of crossreactivity between imipenem-cilastin and meropenem in patients with a nonimmediate hypersensitivity reaction did not report performance of patch tests with both drugs.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Safe use of imipenem after delayed hypersensitivity to meropenem—Value of patch tests

2019

View full text Add to dashboard Cite

There are few data available concerning the possibility of crossreactivity between meropenem and imipenem, which is assumed to be high because they are structurally related and belong to the same antibiotic class. Aiming to evaluate this cross-reactivity we performed patch tests in two patients with a nonimmediate cutaneous adverse drug reaction (CADR) imputable to meropenem. In one of the patients a challenge test with imipenem was also performed. 190MORGADO ET AL. CASE REPORTPatient 1: A 38-year-old woman with systemic lupus erythematosus under treatment with 20 mg oral prednisolone daily developed a morbilliform drug reaction 11 days after starting meropenem and vancomycin for abdominal wall cellulitis.Patient 2: A 61-year-old woman with a postoperative infection developed a maculopapular exanthema 12 days after treatment with vancomycin, ceftriaxone, and metronidazole, and 10 days after meropenem.Patch tests were performed 8 weeks after complete healing of the CADR with the European baseline series, an antibiotics series (Chemotechnique Diagnostics, Vellinge, Sweden), and carbapenems prepared in-house by diluting the intravenous powder in pet. at 10% (more than 30 controls were studied with these preparations who reacted negative). After 48 hours of occlusion, readings were done at day (D)3 and D5-D7 according to ESCD recommendations.In patient 1, who needed additional antibiotic treatments due to her underlying condition, we performed a therapeutic challenge with intravenous imipenem-cilastin 5% in physiologic saline solution on two consecutive days: 50 mg followed within half an hour by 125 mg on D1 and a full dose of 500 mg on D2.In both patients there was a strong positive reaction to meropenem (++) and no reaction to imipenem and other involved drugs (Figure 1). In patients 1, there was no cutaneous reaction after oral provocation. DISCUSSIONCross-reactivity among carbapenems has rarely been addressed by clinical studies. The limited available data show a lack of crossreactivity between these drugs in immediate reactions, suggesting that patients with reported carbapenem allergy may use an alternative carbapenem with caution. 1 There are only three case reports of patients who developed a delayed exanthema to imipenem with good tolerance to meropenem and, conversely, one case of delayed reaction to meropenem with tolerance to imipenem. [2][3][4] Patch tests with carbapenems have a negative predictive value of 100%: in individuals with reported T-cell hypersensitivity to penicillins;negative PT results correlate with a subsequent tolerance to a therapeutic dose of carbapenems. 5 Published reports of a lack of crossreactivity between imipenem-cilastin and meropenem in patients with a nonimmediate hypersensitivity reaction did not report performance of patch tests with both drugs. To our knowledge, this is the first case to illustrate the lack of cross-reactivity by patch testing in patients with this reaction, in patient 1 confirmed by a negative drug challenge.Avoiding a carbapenem can be life-threatening...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Safe use of imipenem after delayed hypersensitivity to meropenem—Value of patch tests

2019

View full text Add to dashboard Cite

show abstract

“…The frequency of reported hypersensitivity reactions to carbapenems is estimated to be approximately 2% to 3% per therapeutic exposure (4). Although there are many studies showing cross-reactivity between penicillins and carbapenems, the clinical cross-reactivity between the individual carbapenems has been described only in few studies (4,5). We report a patient who developed an allergic reaction to meropenem and ertapenem and subsequently tolerated a course of imipenem.…”

Section: Introductionmentioning

confidence: 93%

Cross-Reactivity to Meropenem and Ertapenem Without Imipenem

Ekinci¹,

Kara²,

Yalçin³

et al. 2020

J Crit Intensive Care

View full text Add to dashboard Cite

Carbapenems have a beta-lactam ring that might prone to cause hypersensitivity reactions. We proposed that the clinical cross-reactivity between the individual carbapenems will develop independently from the betalactam ring in this case report. A 75-years-old male patient was admitted to the surgical intensive care unit after whipple procedure for malignant neoplasm of the pancreas. Meropenem and colistin was started because of increased oxygen demand. Most likely drug-induced generalized maculopapular skin rash developed on the first day of the antimicrobial therapy. Followed by discontinuation of meropenem, imipenem-cilastatin therapy was administered without any problem. Because of the increase in the existing infiltrate on the chest x-ray, ertapenem was added as a double-carbapenem strategy. However, it has been discontinued after one dose due to appearing same adverse effects with meropenem. Besides, the lack of allergy history despite prior ceftazidime usage implies that the hypersensitivity reaction of the patient was unlikely related to the beta-lactam ring.

show abstract

“…Cross-reactivity between carbapenems has been infrequently reported [227]; a shared T-cell epitope remains unknown [227]. Cross-reactivity between macrolides also appears rare, with infrequent reports of immediate cross-reactivity noted particularly between those with 14-membered ring such as erythromycin, clarithromycin and roxithromycin and the 15-membered azalide, azithromycin [228].…”

Section: Cross Reactivity In T-cell-mediated Reactionsmentioning

confidence: 99%

Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity

Konvinse

Phillips

White

et al. 2016

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

Purpose of review Antimicrobials are a leading cause of severe T-cell-mediated adverse drug reactions (ADRs). The purpose of this review is to address the current understanding of antimicrobial cross-reactivity and the ready availability of and evidence for in vitro, in vivo and ex vivo diagnostics for T-cell-mediated ADRs. Recent findings Recent literature has evaluated the efficacy of traditional antibiotic allergy management including patch testing, skin prick testing, intradermal testing and oral challenge. While patch and intradermal testing are specific for the diagnosis of immune-mediated (IM) ADRs, they suffer from drug-specific limitations in sensitivity. The use of ex vivo diagnostics, especially ELISpot has been highlighted as a promising new approach to assigning causality. Knowledge of true rates of antimicrobial cross-reactivity aids empirical antibiotic choice in the setting of previous IM-ADRs. Summary In an era of increasing antimicrobial resistance and use of broad-spectrum antimicrobial therapy, ensuring patients are assigned the correct “allergy label” is essential. Re-exposure to implicated antimicrobials, especially in the setting of severe adverse cutaneous reaction is associated with significant morbidity and mortality. The process through which an antibiotic label gets assigned, acted on and maintained is still imprecise. Predicting T-cell-mediated ADRs via personalised approaches, including HLA-typing may pave future pathways to safer antimicrobial prescribing guidelines.

show abstract

Cross-reactivity between carbapenems: Two case reports

Cited by 13 publications

References 5 publications

Safe use of imipenem after delayed hypersensitivity to meropenem—Value of patch tests

Safe use of imipenem after delayed hypersensitivity to meropenem—Value of patch tests

Cross-Reactivity to Meropenem and Ertapenem Without Imipenem

Old dog begging for new tricks: current practices and future directions in the diagnosis of delayed antimicrobial hypersensitivity

Contact Info

Product

Resources

About