Continuous intravenous β-lactam antibiotics in cystic fibrosis patients with severe drug hypersensitivity.

Intravenous antibiotics are widely used in the treatment of pulmonary exacerbation in patients with cystic fibrosis (CF). High rates of allergic reactions to antibiotics, especially β lactams, have been reported in patients with CF. [1] Roehmel J.F. Schwarz C. Mehl A. Stock P. Staab D. Hypersensitivity to antibiotics in patients with cystic fibrosis. J Cyst Fibros. 2014; 13: 205-211 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar These reactions often complicate patient management. Several parenteral antibiotic rapid drug desensitization (RDD) protocols have been described for allergic patients with CF. 2 Legere III, H.J. Palis R.I. Rodriguez Bouza T. Uluer A.Z. Castells M.C. A safe protocol for rapid desensitization in patients with cystic fibrosis and antibiotic hypersensitivity. J Cyst Fibros. 2009; 8: 418-424 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar , 3 Turvey S.E. Cronin B. Arnold A.D. Dioun A.F. Antibiotic desensitization for the allergic patient: 5 years of experience and practice. Ann Allergy Asthma Immunol. 2004; 92: 426-432 Abstract Full Text PDF PubMed Scopus (58) Google Scholar , 4 Whitaker P. Shaw N. Gooi J. Etherington C. Conway S. Peckham D. Rapid desensitization for non-immediate reactions in patients with cystic fibrosis. J Cyst Fibros. 2011; 10: 282-285 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar , 5 Burrows J.A. Toon M. Bell S.C. Antibiotic desensitization in adults with cystic fibrosis. Respirology. 2003; 8: 359-364 Crossref PubMed Scopus (45) Google Scholar In these protocols, the allergenic antibiotic is delivered initially at a highly diluted concentration with a gradual increase in dose and concentration until the desired therapeutic dose is reached. Desensitization is considered successful when the patient tolerates the RDD and the repeated antibiotic administration until the full therapeutic course is completed. Most reported adverse reactions to an RDD protocol occur in the final steps of desensitization and are mild to moderate, [6] Castells M.C. Tennant N.M. Sloane D.E. et al. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol. 2008; 122: 574-580 Abstract Full Text Full Text PDF PubMed Scopus (449) Google Scholar but severe breakthrough reactions occurring during the full-dose treatment and requiring termination of treatment also have been reported. 2 Legere III, H.J. Palis R.I. Rodriguez Bouza T. Uluer A.Z. Castells M.C. A safe protocol for rapid desensitization in patients with cystic fibrosis and antibiotic hypersensitivity. J Cyst Fibros. 2009; 8: 418-424 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar , 3 Turvey S.E. Cronin B. Arnold A.D. Dioun A.F. Antibiotic desensitization for the allergic patient: 5 years of experience and practice. Ann Allergy Asthma Immunol. 2004; 92: 426-432 Abstract Full Text PDF PubMed Scopus (58) Google Scholar , 5 Burrows J.A. Toon M. Bell S.C. Antibiotic desensitization in adults with cystic fibrosis. Respirology. 2003; 8: 359-364 Crossref PubMed Scopus (45) Google Scholar We report our experience with successful treatment using RDD followed by a continuous intravenous β-lactam antibiotic in a subset of patients with CF who could not complete the regular RDD procedure because of severe life-threatening allergic reactions.