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Carbapenem Allergy Management — RACP Adult Medicine MCQ

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HardInfectious DiseasesCarbapenem Allergy ManagementRACP Adult Medicine

A 35-year-old woman with confirmed meropenem allergy (urticaria and angioedema) requires treatment for a multidrug-resistant gram-negative infection. The organism is only susceptible to carbapenems and colistin. She has no penicillin allergy. What is the most appropriate approach?

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Correct answer: A — Carbapenem skin testing and graded challenge if negative

Allergy to one carbapenem does not preclude use of all carbapenems. Cross-reactivity between carbapenems varies (meropenem and ertapenem share a similar side chain; imipenem differs). Skin testing to the specific carbapenem followed by graded challenge if negative is the recommended approach. Carbapenem-penicillin cross-reactivity is very low (<1%). Desensitisation is used if skin test is positive and no alternatives exist.

Reference: ASCIA – 2024 – Drug Allergy; Kula 2014 Carbapenem Cross-Reactivity