EA 7379 EpiDermE, Université Paris Est Créteil, Créteil, France.
Department of Dermatology, Hôpital Nord, Amiens, France.
Br J Dermatol. 2018 Aug;179(2):329-336. doi: 10.1111/bjd.16365. Epub 2018 May 14.
The proportion of severe cutaneous adverse reactions (SCARs) that could be avoided if medication use was consistent with good medical practice is unknown.
To estimate the proportion of SCARs related to inappropriate medication use.
We carried out a retrospective study of all validated SCARs collected in a French registry between 2003 and 2016. For each case, all plausible drugs suspected of inducing SCARs (i.e. not just the drug regarded as 'the most probable') were considered with regard to (i) prescription for an inappropriate indication, (ii) unintentional rechallenge despite a previous allergy to the drug or (iii) self-medication with prescription medicines.
In total, 602 cases were included in the analyses. Antibiotics, anticonvulsants and allopurinol were the drugs most frequently involved, accounting for more than 50% of all cases. All suspected medications were considered to have been appropriately used for 417 of the 602 individuals included in the study population [69·3%, 95% confidence interval (CI) 65·6-73·0] and inappropriately used for 144 individuals (23·9%, 95% CI 20·5-27·3). These inappropriate uses were due mainly to prescriptions for an inappropriate indication (65·8%, 95% CI 58·4-73·2) or unintentional rechallenge (20·9%, 95% CI 14·6-27·2). Allopurinol and co-trimoxazole were the drugs most frequently involved in inappropriate indications. Antibiotics were the largest group involved in unintentional rechallenge. Nonsteroidal anti-inflammatory drugs, available on prescription, were most frequently involved in inappropriate self-medication.
Our results underline the need for respecting the appropriate indication for drugs in order to reduce the incidence of SCARs. Reducing unintentional rechallenge also seems to be a necessary preventive measure.
如果药物使用符合良好的医疗实践，那么可以避免的严重皮肤不良反应 (SCAR) 的比例尚不清楚。
估计与不当用药相关的 SCAR 比例。
我们对 2003 年至 2016 年间在法国登记处收集的所有经证实的 SCAR 进行了回顾性研究。对于每例病例，都考虑了所有可疑的可能引起 SCAR 的药物（即不仅是被认为“最可能”的药物），这些药物涉及（i）处方用于不适当的适应症，（ii）尽管以前对药物过敏仍意外再次用药，或（iii）自行使用处方药物。
共有 602 例病例纳入分析。抗生素、抗惊厥药和别嘌醇是最常涉及的药物，占所有病例的 50%以上。在纳入研究人群的 602 名个体中，有 417 名（69.3%，95%置信区间[CI]为 65.6-73.0）所有可疑药物均被认为使用得当，而 144 名（23.9%，95% CI 为 20.5-27.3）被认为使用不当。这些不当使用主要是由于处方用于不适当的适应症（65.8%，95% CI 为 58.4-73.2）或意外再次用药（20.9%，95% CI 为 14.6-27.2）。别嘌醇和复方磺胺甲噁唑是最常涉及不适当适应症的药物。抗生素是意外再次用药涉及的最大药物类别。可处方的非甾体抗炎药是最常涉及不适当自我用药的药物。
我们的结果强调需要遵守药物的适当适应症，以降低 SCAR 的发生率。减少意外再次用药似乎也是一项必要的预防措施。
