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Updated: Aug 7, 2025
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Published on: May 31, 2021
Meropenem allergy testing performed at the bedside of hospitalized patients labelled with a penicillin allergy
Laura Marín1, Beatriz Moya1, María José Peñalver1
1Department of Allergy, Hospital Universitario, Madrid, Spain; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
Background:
Meropenem is a widely prescribed beta-lactam for hospitalized patients. There are few data on meropenem allergy assessments in inpatients with a reported history of penicillin allergy who require a treatment with meropenem. This can lead to the use of less effective second-line antibiotics that may increase antibiotic resistances. We aimed to evaluate the clinical outcomes of a meropenem allergy assessment in admitted patients with a reported history of penicillin allergy that required meropenem for the treatment of an acute infection.
Methods:
A retrospective analysis was performed on 182 inpatients labelled with a penicillin-allergy who received meropenem after an allergy assessment. The allergy study was performed bedside if meropenem was required urgently. The study included skin prick tests (SPTs) followed by an intradermal skin test (IDT) to meropenem, and a meropenem drug challenge test (DCT). If a non-immediate reaction to a beta-lactam was suspected, it was initiated with patch tests.
Results:
The median age of the patients was 59.7 years (range 28-95) and 80 (44%) were women. A total of 196 sets of diagnostic workups were performed, with 189 (96.4%) of them being tolerated. Only two patients had a positive meropenem IV DCT, both presenting a non-severe cutaneous reaction that completely resolved after treatment.
Conclusions:
This study evidenced that a bedside meropenem allergy assessment of hospitalized patients labelled with a 'penicillin allergy' who require a broad-spectrum antibiotic for empiric coverage is a safe and effective procedure, avoiding the use of second-line antimicrobial agents.
Insights
Meropenem allergy assessments are safe and effective for hospitalized patients with a penicillin allergy history. This approach avoids using less effective second-line antibiotics, thereby reducing antibiotic resistance.
Area of Science:
- Infectious Diseases
- Clinical Immunology
- Pharmacology
Background:
- Meropenem is a crucial beta-lactam antibiotic for hospitalized patients.
- Limited data exist on meropenem allergy assessments for inpatients with a penicillin allergy history.
- This gap can lead to suboptimal second-line antibiotic use, potentially increasing antibiotic resistance.
Purpose of the Study:
- To evaluate the clinical outcomes of meropenem allergy assessments in hospitalized patients with a reported penicillin allergy.
- To determine the safety and efficacy of bedside meropenem allergy testing.
Main Methods:
- Retrospective analysis of 182 inpatients with a penicillin allergy label who underwent meropenem allergy assessment.
- Bedside allergy testing including skin prick tests (SPTs), intradermal tests (IDTs), and drug challenge tests (DCTs) for meropenem.
- Patch testing initiated for suspected non-immediate beta-lactam reactions.
Main Results:
- 196 diagnostic workups were performed, with 96.4% being well-tolerated.
- Only two patients (1.1%) showed a positive meropenem IV DCT, with mild, self-resolving cutaneous reactions.
- The procedure was safe and effective in identifying patients who could safely receive meropenem.
Conclusions:
- Bedside meropenem allergy assessment is a safe and effective strategy for inpatients with a 'penicillin allergy' history requiring broad-spectrum antibiotics.
- This assessment helps avoid the use of less effective alternative antimicrobial agents.
- Implementing such assessments can contribute to antimicrobial stewardship and combat antibiotic resistance.
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