Hypersensitivity to antibiotics in patients with cystic fibrosis

J Cyst Fibros. 2014 Mar;13(2):205-11. doi: 10.1016/j.jcf.2013.10.002. Epub 2013 Oct 26.


Background: Hypersensitivity reactions to parenterally administered antibiotics (HRPA) are a substantial problem in managing CF. We conducted this observational study to assess their nature and frequency as well as risk factors.

Methods: By reviewing medical records and conducting interviews, age, sex, FEV1, ∆F508-genotype, pseudomonal colonisation, allergy history, antibiotic exposure and HRPA were recorded.

Results: Of 100 patients included in the study, 60 had ≥1 HRPA. Overall, 3205 antibiotic courses with 185 HRPA were ascertained. Changes in therapy followed 65% of HRPA. Eighty-four percent of severe HRPA occurred during days 1-4. Approximately 10% of treatment courses with cefepime and piperacillin/tazobactam caused HRPA. Years of pseudomonal colonisation and cumulative annual exposure were significant risk factors.

Conclusions: During days 1-4 of antibiotic treatment patients are at elevated risk for HRPA. HRPA are drug-specific and dependent on cumulative annual exposure. Elucidation of HRPA's immunological mechanisms and development of diagnostic algorithms for clinical use are required.

Keywords: Allergy; Antibiotic treatment; Antibiotics; Aztreonam; Ceftazidime; Colistin; Cystic fibrosis; Drug Allergy; Drug hypersensitivity; Hypersensitivity; Piperacillin; Tazobactam.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / classification
  • Child
  • Cystic Fibrosis / drug therapy*
  • Dose-Response Relationship, Drug
  • Drug Hypersensitivity* / diagnosis
  • Drug Hypersensitivity* / epidemiology
  • Drug Hypersensitivity* / physiopathology
  • Drug Hypersensitivity* / prevention & control
  • Female
  • Humans
  • Infusions, Parenteral
  • Male
  • Pseudomonas Infections / prevention & control*
  • Risk Adjustment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors


  • Anti-Bacterial Agents