![]() We conclude that meropenem may be given safely to patients reporting a history of non-anaphylactic or anaphylactic allergic reactions to penicillins without penicillin skin testing. To the best of our knowledge, this is the first prospective clinical study demonstrating that meropenem may be safely given to patients with known/unknown allergic reactions to penicillin, including those with anaphylactic reactions, without penicillin skin testing. Based on these data and our previous clinical experience, there appears to be little/no potential cross reactivity between meropenem and penicillins even in patients with a definite history of anaphylactic reactions to penicillins. During a 12-month period, 110 patients with non-anaphylactic (59) and anaphylactic (51) penicillin allergic reactions tolerated prolonged meropenem therapy (1-4 weeks) safely without any allergic reactions. Among patients with a penicillin allergy, 2-7 show cross-sensitivity to cephalosporins. Patients were divided into two groups, depending on the nature of their penicillin allergic reactions. As great as 2 of the population is allergic to penicillin. Penicillin skin testing was not done in this "real world" clinical study. This topic reviews immediate allergic reactions to penicillins, which are most often defined as reactions that develop within minutes to one hour of administration. Thus, a systematic approach to the evaluation of penicillin allergy is necessary. Since early empiric therapy in such patients is essential, there is often no time for penicillin skin testing. However, penicillins are among the leading causes of drug-induced anaphylaxis, including fatalities. Accordingly, over a 12-month period we prospectively monitored 110 patients treated with meropenem reporting penicillin allergic reactions for that 12-month period. This study was conducted to document our clinical practice experience. The risk of cross-reactivity is dependent on the similarity of the cephalosporin side chain to penicillin or amoxicillin. Although we have had extensive clinical experience since 1996 using meropenem safely in treating hundreds of patients with reported allergic reactions to penicillin without any adverse events, we have not published our experience. True or false: Cephalosporins can never be safely prescribed to patients with a true IgE-mediated penicillin allergy (anaphylaxis, hypotension, wheezing, laryngeal edema, angioedema or urticaria). Over the years, meropenem has become the mainstay of empiric therapy for serious systemic infections in critically ill patients.
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