Safety of aztreonam in patients with cystic fibrosis and allergy to beta-lactam antibiotics

In an open clinical trial, aztreonam was administered repeatedly to 15 cystic fibrosis patients who were chronically infected with Pseudomonas aeruginosa and had previously had severe hypersensitivity reactions to other beta-lactam antibiotics, including anaphylactic shock, generalized urticaria, and drug-associated fever. After negative results in a skin-prick test and a lack of reaction to an intravenous test dose of aztreonam, the patients were treated with aztreonam (150 mg/[kg.d]) in combination with tobramycin (10-20 mg/[kg.d]) for 14-day periods at 3- to 4-month intervals. To date, a total of 56 course of aztreonam have been administered to these patients (three to six courses per patient), and no type 1 hypersensitivity reactions have occurred. However, as a result of drug-associated fever, the administration of aztreonam had to be discontinued in two of 15 cases. The remaining 13 patients have tolerated treatment well.