https://www.cidrap.umn.edu/antimicr...s-linked-rare-drug-associated-skin-conditions
Antibiotics linked to rare, drug-associated skin conditions
News brief
Today at 3:31 p.m.
Chris Dall, MA
Topics
Antimicrobial Stewardship
SHARE
A systematic review and meta-analysis found that antibiotics may be associated with more than a quarter of cases of rare, serious drug reactions that affect the skin and mucous membranes, researchers reported yesterday in JAMA Dermatology.
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are severe-drug-associated reactions that start with flu-like symptoms and progress to a painful rash and blisters on the skin and mucous membranes of the mouth, nose, eyes, and genitals. While SJS/TEN cases are rare (affecting 1 to 10 individuals per million population per year), they are considered the most severe form of drug hypersensitivity reaction, with mortality rate of up to 50%. Antibiotics are among the commonly implicated drugs, but the level of risk associated with antibiotics is not known.
To assess the risk, researchers with the University of Toronto and Vanderbilt University conducted a review and meta-analysis of experimental and observational studies that described SJS/TEN risk factors. The primary outcome was the prevalence of antibiotic-associated SJS/TEN presented as pooled proportions.
Of the 64 studies reviewed, 38 studies with 2,917 patients described patient-level associations. A single drug was associated with 86% (95% confidence interval [CI], 80% to 92%) of all SJS/TEN cases, and 14% were associated with multiple potential drug triggers, unknown drug names, infections, or unknown causes. The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24% to 33%), with moderate certainty of evidence. The prevalence of antibiotics triggering drug-associated SJS/TEN was 35% (95% CI, 29% to 40%).
Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22% to 44%) of cases, followed by penicillins (22%; 95% CI, 17% to 28%), cephalosporins (11%; 95% CI, 6% to 17%), fluoroquinolones (4%; 95% CI, 1% to 7%), and macrolides (2%; 95% CI, 1% to 5%).
"The study highlights the importance of using antibiotics judiciously and limiting sulfonamide antibiotics to only specific indications and durations, as well as early recognition and prompt discontinuation of the implicated drugs to reduce morbidity and mortality associated with SJS/TEN," the study authors wrote.
Antibiotics linked to rare, drug-associated skin conditions
News brief
Today at 3:31 p.m.
Chris Dall, MA
Topics
Antimicrobial Stewardship
SHARE
A systematic review and meta-analysis found that antibiotics may be associated with more than a quarter of cases of rare, serious drug reactions that affect the skin and mucous membranes, researchers reported yesterday in JAMA Dermatology.
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are severe-drug-associated reactions that start with flu-like symptoms and progress to a painful rash and blisters on the skin and mucous membranes of the mouth, nose, eyes, and genitals. While SJS/TEN cases are rare (affecting 1 to 10 individuals per million population per year), they are considered the most severe form of drug hypersensitivity reaction, with mortality rate of up to 50%. Antibiotics are among the commonly implicated drugs, but the level of risk associated with antibiotics is not known.
To assess the risk, researchers with the University of Toronto and Vanderbilt University conducted a review and meta-analysis of experimental and observational studies that described SJS/TEN risk factors. The primary outcome was the prevalence of antibiotic-associated SJS/TEN presented as pooled proportions.
The study highlights the importance of using antibiotics judiciously.
Of the 64 studies reviewed, 38 studies with 2,917 patients described patient-level associations. A single drug was associated with 86% (95% confidence interval [CI], 80% to 92%) of all SJS/TEN cases, and 14% were associated with multiple potential drug triggers, unknown drug names, infections, or unknown causes. The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24% to 33%), with moderate certainty of evidence. The prevalence of antibiotics triggering drug-associated SJS/TEN was 35% (95% CI, 29% to 40%).
Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22% to 44%) of cases, followed by penicillins (22%; 95% CI, 17% to 28%), cephalosporins (11%; 95% CI, 6% to 17%), fluoroquinolones (4%; 95% CI, 1% to 7%), and macrolides (2%; 95% CI, 1% to 5%).
"The study highlights the importance of using antibiotics judiciously and limiting sulfonamide antibiotics to only specific indications and durations, as well as early recognition and prompt discontinuation of the implicated drugs to reduce morbidity and mortality associated with SJS/TEN," the study authors wrote.