Romano Antonino, Viola Marinella, Guéant-Rodriguez Rosa-Maria, Gaeta Francesco, Valluzzi Rocco, Guéant Jean-Louis
Università Cattolica del Sacro Cuore, Complesso Integrato Columbus, Rome, Italy.
Ann Intern Med. 2007 Feb 20;146(4):266-9. doi: 10.7326/0003-4819-146-4-200702200-00005.
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.
To assess the tolerability of meropenem in patients with documented penicillin allergy.
Prospective skin testing and antibiotic challenge.
Allergy units of 2 Italian medical centers.
104 consecutive participants with immediate hypersensitivity reactions to penicillins and positive skin test results to at least 1 penicillin reagent.
Skin tests to meropenem and, if results were negative, challenges with escalating doses of meropenem.
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.
Challenges were not followed by therapeutic courses.
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.
尽管临床医生因潜在的交叉反应性而避免给青霉素过敏患者使用美罗培南，但青霉素与美罗培南之间的交叉反应率尚未经过前瞻性测定。
评估美罗培南在有青霉素过敏记录患者中的耐受性。
前瞻性皮肤试验和抗生素激发试验。
意大利2个医疗中心的过敏科。
104名对青霉素有速发型过敏反应且对至少1种青霉素试剂皮肤试验结果呈阳性的连续参与者。
美罗培南皮肤试验，若结果为阴性，则进行递增剂量的美罗培南激发试验。
1名参与者（0.9%[95%CI，0.02%至5.2%]）对美罗培南皮内试验结果呈阳性。其余103名对美罗培南皮肤试验结果为阴性的参与者耐受递增剂量激发试验。
激发试验后未进行治疗疗程。
这些数据表明青霉素与美罗培南之间的交叉反应率较低。因此，应重新考虑在青霉素过敏患者中避免使用美罗培南治疗的做法。对于特别需要美罗培南治疗的患者，作者建议进行治疗前皮肤试验，因为阴性结果表明耐受性良好。
