Publications

Modification of risk factors in patients who have had myocardial infarctions has received little attention in the literature. Yet, major modifiable risk factors for recurrent coronary heart disease, including hypertension, smoking, increased serum cholesterol levels, sedentary lifestyle, and obesity are the same risk factors for its development. Although coronary atherosclerosis is already established in patients who have had a myocardial infarction, evidence suggests that important reductions in recurrent coronary heart disease and death can be achieved through secondary prevention programs that modify risk factors. The high risk for recurrence and mortality in patients who survive a heart attack means that substantial reductions in the rates of these events can be achieved with relatively small reductions in risk factors. Patients who have had a myocardial infarction are also active participants in health care and are likely to be highly motivated to modify their risks for cardiac disease.

We examined the potential for IgE-mediated cross-reactivity between the carbepenems, a new class of beta-lactam antibiotics, represented by imipenem, and penicillins. In vivo skin testing with the relevant imipenem and penicillin determinants was undertaken. Having determined the concentrations of imipenem materials that did not induce false positive skin tests in nonpenicillin-allergic control subjects, we tested 40 subjects with a history of penicillin-allergic reactions. Twenty of these subjects were found to be nonallergic to penicillin on skin testing, and none of these subjects reacted to the imipendem determinants. In contrast, half the 20 subjects who were positive to one or more penicillin determinants also reacted to imipenem reagents. There was a good correlation between the penicillin and imipenem reagents to which the patients reacted. Imipenem should only be administered to penicillin-allergic subjects with similar precautions of penicillin administration to such patients.