Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan.
Clin Infect Dis. 2014 May;58(10):1377-85. doi: 10.1093/cid/ciu126. Epub 2014 Mar 5.
Systemic antibiotics are a major cause of severe cutaneous adverse reactions (SCARs). The selection of alternative antibiotics and management for SCARs patients with underlying infections can be challenging.
We retrospectively analyzed 74 cases of SCARs, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), related to use of systemic antibiotics in Taiwan from January 2006 to January 2012. We analyzed the causative antibiotics, clinical features, organ involvements, and mortality. We also assessed patient tolerability to alternative antibiotics after the development of antibiotic-related SCARs.
The most common causes of SCARs were penicillins and cephalosporins for SJS/TEN and AGEP; glycopeptides for DRESS. Fatality was more frequent in the SJS/TEN group. In patients with SJS/TEN, higher mortality was associated with old age and underlying sepsis before the development of SCARs. The majority of patients with penicillin- or cephalosporin-related SCARs were able to tolerate quinolones, glycopeptides, and carbapenems.
Complicated underlying conditions and infections may increase mortality in patients with antibiotic-related SCARs. The selection of structurally different alternative drugs is important to avoid recurrence.
全身性抗生素是严重皮肤不良反应（SCARs）的主要原因。对于有基础感染的 SCARs 患者，选择替代抗生素和管理方法可能具有挑战性。
我们回顾性分析了 2006 年 1 月至 2012 年 1 月期间在台湾因使用全身性抗生素而发生的 74 例 SCARs 病例，包括史蒂文斯-约翰逊综合征（SJS）、中毒性表皮坏死松解症（TEN）、药物疹伴嗜酸性粒细胞增多和全身症状（DRESS）和急性泛发性发疹性脓疱病（AGEP）。我们分析了致病抗生素、临床特征、器官受累和死亡率。我们还评估了发生抗生素相关性 SCARs 后患者对替代抗生素的耐受性。
SJS/TEN 和 AGEP 最常见的 SCARs 原因是青霉素类和头孢菌素类；DRESS 的原因是糖肽类。SJS/TEN 组死亡率较高。在 SJS/TEN 患者中，高龄和发生 SCARs 前合并败血症与较高的死亡率相关。大多数青霉素或头孢菌素相关性 SCARs 患者能够耐受喹诺酮类、糖肽类和碳青霉烯类药物。
合并复杂基础疾病和感染可能会增加抗生素相关性 SCARs 患者的死亡率。选择结构不同的替代药物很重要，以避免复发。
