Brief communication: tolerability of meropenem in patients with IgE-mediated hypersensitivity to penicillins

Ann Intern Med. 2007 Feb 20;146(4):266-9. doi: 10.7326/0003-4819-146-4-200702200-00005.


Background: Although clinicians avoid giving meropenem to patients with penicillin allergy because of potential cross-reactivity, the rate of cross-reactivity between penicillins and meropenem has not been prospectively determined.

Objective: To assess the tolerability of meropenem in patients with documented penicillin allergy.

Design: Prospective skin testing and antibiotic challenge.

Setting: Allergy units of 2 Italian medical centers.

Patients: 104 consecutive participants with immediate hypersensitivity reactions to penicillins and positive skin test results to at least 1 penicillin reagent.

Measurements: Skin tests to meropenem and, if results were negative, challenges with escalating doses of meropenem.

Results: One participant (0.9% [95% CI, 0.02% to 5.2%]) had a positive intradermal test result to meropenem. The remaining 103 participants with negative skin test results to meropenem tolerated escalating dose challenges.

Limitation: Challenges were not followed by therapeutic courses.

Conclusions: These data indicate a low rate of cross-reactivity between penicillins and meropenem. Therefore, the practice of avoiding meropenem therapy in penicillin-allergic patients should be reconsidered. In patients who especially require meropenem treatment, the authors recommend pretreatment skin tests because negative results indicate tolerability.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / immunology
  • Anticoagulants / therapeutic use
  • Cross Reactions
  • Female
  • Humans
  • Hypersensitivity, Immediate / chemically induced*
  • Male
  • Meropenem
  • Middle Aged
  • Penicillins / adverse effects*
  • Prospective Studies
  • Skin Tests
  • Thienamycins / administration & dosage
  • Thienamycins / adverse effects*
  • Thienamycins / immunology


  • Angiotensin II Type 1 Receptor Blockers
  • Anti-Bacterial Agents
  • Anticoagulants
  • Penicillins
  • Thienamycins
  • Meropenem