CHRU de Tours, Service de Pharmacosurveillance, Centre Régional de Pharmacovigilance Centre-Val de Loire, Tours, France.
Université de Tours, Université de Nantes, INSERM, methodS in Patients-centered outcomes and HEalth ResEarch (SPHERE) - UMR 1246, Tours, France.
J Eur Acad Dermatol Venereol. 2021 Dec;35(12):2415-2420. doi: 10.1111/jdv.17631. Epub 2021 Sep 13.
Growing evidence indicates that amoxicillin induces herpesvirus replication in vitro. As these play a central pathophysiological role in Drug Reaction with Eosinophilia and Systemic Symptoms syndrome (DRESS), amoxicillin could present with specific DRESS features.
To characterize the onset patterns of amoxicillin-associated DRESS.
All cases of DRESS (Kardaun score ≥4) involving amoxicillin and reported in the French Pharmacovigilance Database between January 1, 2004 and November 30, 2019 were included. Onset circumstances for these cases were categorized considering the onset delay from amoxicillin initiation, and the presence of concomitant medications with a compatible time to onset.
A total of 146 probable cases or definite cases of DRESS were included. Three onset circumstances were identified: (i) 'amoxicillin clear culprit' where amoxicillin was the sole suspect drug or when concomitant drugs of compatible time to onset were not reported to cause DRESS (n = 62); (ii) 'amoxicillin possible culprit' in the presence of other potentially culprit drugs in addition to amoxicillin (n = 44) and (iii) 'flare' where amoxicillin, used after DRESS onset, induced flare-up reactions (n = 40). The median time to onset was 5 days (IQR 2-11) in 'clear culprit', and 18 days (IQR 7-26) in 'possible culprit' cases. In 'flare' cases, the median latency between amoxicillin initiation and flare-up reactions was 3 days (IQR 2-5).
Amoxicillin can induce DRESS with a specific early onset and exacerbate DRESS from another drug.
越来越多的证据表明阿莫西林可诱导疱疹病毒在体外复制。由于这些病毒在药物反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征的中心病理生理学中起关键作用，因此阿莫西林可能具有特定的 DRESS 特征。
描述阿莫西林相关性 DRESS 的发病模式。
纳入了 2004 年 1 月 1 日至 2019 年 11 月 30 日期间在法国药物警戒数据库中报告的所有涉及阿莫西林的 DRESS 病例（Kardaun 评分≥4）。根据阿莫西林起始后发病延迟情况以及同时存在与发病时间相符的药物，对这些病例的发病情况进行分类。
共纳入 146 例可能或确诊的 DRESS 病例。确定了三种发病情况：（i）“阿莫西林明确元凶”，即阿莫西林是唯一的可疑药物，或同时存在与发病时间相符的其他药物，但未报告这些药物引起 DRESS（n=62）；（ii）“阿莫西林可能元凶”，除了阿莫西林之外还存在其他可能元凶药物（n=44）；（iii）“发作”，即阿莫西林在 DRESS 发作后使用，引起了发作反应（n=40）。在“明确元凶”病例中，中位发病时间为 5 天（IQR 2-11），在“可能元凶”病例中为 18 天（IQR 7-26）。在“发作”病例中，阿莫西林起始与发作反应之间的潜伏期中位数为 3 天（IQR 2-5）。
阿莫西林可引起特定的早期发病 DRESS，并可加重其他药物引起的 DRESS。
