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Adverse Reactions Associated with Penicillins, Carbapenems, Monobactams, and Clindamycin: A Retrospective
Emily H Liang1, Lie H Chen2, Eric Macy3
1Southern California Permanente Medical Group, Department of Allergy, Los Angeles Medical Center, Los Angeles, Calif.
Background:
Limited population-based data on penicillin-, carbapenem-, monobactam-, and clindamycin-associated reported adverse reactions exist.
Objective:
To collect data on penicillin, carbapenem, monobactam, and clindamycin usage and associated adverse reactions.
Methods:
Data from January 1, 2009, to December 31, 2017, in Kaiser Permanente Southern California were collected.
Results:
There were 6,144,422 unique individuals, mean age 33.6 ± 21.1 years, 52.2% females, with at least 1 health care visit during the 9-year study interval, for a total of 37,387,313 patient-years of follow-up. This population was exposed to 5,617,402 courses of oral penicillins, 370,478 courses of parenteral penicillins, 59,645 courses of parenteral carbapenems or monobactams, 817,232 courses of oral clindamycin, and 215,880 courses of parenteral clindamycin. New penicillin allergies were reported more commonly after parenteral (0.85%) compared with oral (0.74%) exposures (P < .0001). There were 22 cases (1 in 255,320) of oral penicillin-associated anaphylaxis and 3 cases (1 in 123,792) of parenteral penicillin-associated anaphylaxis (P < .001). There were 2 clindamycin-associated anaphylaxis cases, 1 (1 in 817,232) oral and 1 (1 in 215,880) parenteral. There were 2 (1 in 2,993,940) penicillin-associated serious cutaneous adverse reaction (SCAR) cases, but both also had co-trimoxazole coexposure within 45 days. There was 1 (1 in 1,033,112) clindamycin-associated SCAR. Clostridioides difficile infection was more common after parenteral exposures, and with extended-spectrum penicillins, beta-lactamase combinations, carbapenems, monobactam, and clindamycin exposures compared with oral penicillins or clindamycin.
Conclusions:
Only 1 of 1543 (0.065%) oral and 1 of 1030 (0.097%) parenteral penicillin-associated allergy reports were confirmed to be anaphylaxis. C. difficile was more common after parenteral versus oral penicillin, carbapenem, monobactam, and clindamycin exposures, and with broader spectrum antibiotic exposures.
Insights
Penicillin and clindamycin allergies are rare, with anaphylaxis confirmed in less than 0.1% of reported cases. Clostridioides difficile infection risk increased with parenteral antibiotics like carbapenems and monobactams.
Area of Science:
- Pharmacovigilance
- Infectious Diseases
- Clinical Pharmacology
Background:
- Limited population-based data exists for adverse reactions associated with penicillin, carbapenem, monobactam, and clindamycin.
- Understanding these risks is crucial for safe antibiotic prescribing.
Purpose of the Study:
- To gather data on the usage of penicillin, carbapenem, monobactam, and clindamycin.
- To identify and quantify associated adverse reactions, including allergies and Clostridioides difficile infections.
Main Methods:
- A retrospective analysis of electronic health records from Kaiser Permanente Southern California (2009-2017).
- Inclusion of over 6 million unique individuals and 37 million patient-years of follow-up.
- Analysis of antibiotic exposure data and reported adverse events.
Main Results:
- Penicillin allergy reports were more frequent with parenteral than oral routes (0.85% vs 0.74%).
- Anaphylaxis was rare, confirmed in 0.065% of oral and 0.097% of parenteral penicillin allergy reports.
- Clostridioides difficile infection was more common with parenteral antibiotics, carbapenems, monobactams, and clindamycin compared to oral penicillins.
Conclusions:
- Confirmed anaphylaxis rates for penicillin are very low.
- Parenteral administration and broader-spectrum antibiotics (carbapenems, monobactams, clindamycin) are associated with a higher risk of Clostridioides difficile infection.
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