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Antibiotic-related mortality influenced by underlying conditions
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In patients with severe cutaneous adverse reactions related to systemic antibiotics, the presence of underlying comorbidities may contribute to increased mortality, according to recent findings from Taiwan.
In the retrospective study, researchers evaluated 74 adult patients with antibiotic-related severe cutaneous adverse reactions who presented for treatment from 2006 to January 2012 at Chang Gung Memorial Hospital, Taiwan. The types of reactions included in the analysis included Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug interactions with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis.
The researchers utilized two approaches, the Naranjo algorithm and the algorithm of drug causality assessment for SJS/TEN, also known as ALDEN, to determine the antibiotic responsible for the suspected adverse reaction. Laboratory and clinical findings were used to determine the organs of the body affected by the severe reactions, according to the study results published in Clinical Infectious Diseases.
The severity-of-illness score for TEN (SCORTEN) was used to assess the projected mortality rate in terms of the actual mortality rate in patients with SJS/TEN. Additionally, the researchers studied the tolerability of alternative antibiotic regimens in patients who had antibiotic-related severe cutaneous adverse reactions.
The researchers found that in patients with SJS/TEN and in patients with acute generalized exanthematous pustulosis, penicillins and cephalosporins caused most reactions, whereas glycopeptides were the most prevalent causes of drug interactions with eosinophilia and systemic symptoms. There was a higher mortality rate in the SJS/TEN patients; this increased mortality was found to be related to older patients and those with pre-existing sepsis. Most patients who died had underlying conditions, such as congestive heart failure, chronic renal failure or end-stage renal disease, diabetes mellitus or cancer, according to the study findings.
In terms of alternate therapies, most patients with severe cutaneous adverse reactions related to penicillins or cephalosporins were able to tolerate quinones, glycopeptides and carbapenems.
The researchers emphasized the importance of recognizing the signs of severe cutaneous adverse reactions and discontinuing treatment with causative agent as soon as possible.
“Antibiotics may cause various types of allergic drug reactions ranging from mild to serious cutaneous reactions, organ-specific reactions, or systemic reactions,” the researchers wrote. “Careful clinical monitoring for early sign of [severe cutaneous adverse reactions] and immediate withdrawal of the suspected drugs are the most important steps for the management of these conditions.”
Disclosure: The researchers report no relevant financial disclosures.
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