Hypersensitivity to antibiotics in patients with cystic fibrosis

Abstract

Background

Hypersensitivity reactions to parenterally administered antibiotics (HRPA) are a substantial problem in managing CF. We conducted this observational study to assess their nature and frequency as well as risk factors.

Methods

By reviewing medical records and conducting interviews, age, sex, FEV1, ∆F508-genotype, pseudomonal colonisation, allergy history, antibiotic exposure and HRPA were recorded.

Results

Of 100 patients included in the study, 60 had ≥ 1 HRPA. Overall, 3205 antibiotic courses with 185 HRPA were ascertained. Changes in therapy followed 65% of HRPA. Eighty-four percent of severe HRPA occurred during days 1–4. Approximately 10% of treatment courses with cefepime and piperacillin/tazobactam caused HRPA. Years of pseudomonal colonisation and cumulative annual exposure were significant risk factors.

Conclusions

During days 1–4 of antibiotic treatment patients are at elevated risk for HRPA. HRPA are drug-specific and dependent on cumulative annual exposure. Elucidation of HRPA's immunological mechanisms and development of diagnostic algorithms for clinical use are required.