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Lu Y, Zhou L, Zou Y, Wei H, Zhou Y, Guo X, Li Q, Ye Y, Zhang L. Antibiotic-induced severe cutaneous adverse reactions: a single-center retrospective study over ten years. Front Immunol 2024; 15:1415830. [PMID: 39091503 PMCID: PMC11291224 DOI: 10.3389/fimmu.2024.1415830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024] Open
Abstract
Objective Severe cutaneous adverse reactions (SCARs) are rare but life-threatening, with antibiotics being the main cause. This retrospective study from a single center was designed to analyze the culprit drugs, clinical features and treatment outcomes of antibiotic-induced SCARs. Methods We analyzed cases of antibiotic-induced SCARs in a tertiary hospital in China between January 2013 and January 2024, including Steven-Johnson syndrome (SJS) or Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-TEN) overlap, toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Descriptive analysis of the demographic characteristics, clinical manifestations, treatment and prognosis were carried out. Results Among 354 cases of SCARs, 63 validated antibiotic-related cases were included. Cephalosporins (31.7%), penicillins (25.4%), and quinolones (19.0%) were the most common triggers for SCARs. Overall, liver (50.8%), lungs (31.7%), and kidneys (23.8%) were the most frequently affected organ in SCARs cases. Eight patients (28.6%) in the SJS/SJS-TEN overlap group and 8 patients (80.0%) in the TEN group received combination therapy of corticosteroids and IVIG. Patients with SCARs caused by penicillins or cephalosporins could receive alternative treatments such as lincomamides, quinolones, and tetracyclines. The mortality rate in the TEN group was the highest at 20.0%, followed by the SJS/SJS-TEN overlap group (7.1%), and no deaths were observed in the DRESS and AGEP groups. Conclusion The identification of the culprit antibiotics and the application of alternative antibiotic therapies are crucial for the management of antibiotic-induced SCARs. If complicated underlying conditions and complications like advanced age, cancer and pneumonia coexist with SCARs, patients might be more at risk for mortality.
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Affiliation(s)
- Yun Lu
- Department of Pharmacy, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Lu Zhou
- Department of Pharmacy, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Ya Zou
- Department of Pharmacy, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Hua Wei
- Department of Pharmacy, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Yan Zhou
- Department of Pharmacy, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Xirui Guo
- Department of Pharmacy, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Qinchuan Li
- Department of Pharmacy, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Yongqin Ye
- Department of Pharmacy, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
| | - Liwen Zhang
- Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China
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Wang T, Yang J, Yang F, Cheng Y, Huang Z, Li B, Yang L, Xing Q, Luo X. The association between HLA-B variants and amoxicillin-induced severe cutaneous adverse reactions in Chinese han population. Front Pharmacol 2024; 15:1400239. [PMID: 38863977 PMCID: PMC11165025 DOI: 10.3389/fphar.2024.1400239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/07/2024] [Indexed: 06/13/2024] Open
Abstract
Background Amoxicillin (AMX) is among the most prescribed and the best tolerated antimicrobials worldwide. However, it can occasionally trigger severe cutaneous adverse reactions (SCAR) with a significant morbidity and mortality. The genetic factors that may be relevant to AMX-induced SCAR (AMX-SCAR) remain unclear. Identification of the genetic risk factor may prevent patients from the risk of AMX exposure and resume therapy with other falsely implicated drugs. Methodology Four patients with AMX-SCAR, 1,000 population control and 100 AMX-tolerant individuals were enrolled in this study. Both exome-wide and HLA-based association studies were conducted. Molecular docking analysis was employed to simulate the interactions between AMX and risk HLA proteins. Results Compared with AMX-tolerant controls, a significant association of HLA-B*15:01 with AMX-SCAR was validated [odds ratio (OR) = 22.9, 95% confidence interval (CI): 1.68-1275.67; p = 7.34 × 10-3]. Moreover, 75% carriers of HLA-B*15:01 in four patients with AMX-SCAR, and the carrier frequency of 10.7% in 1,000 control individuals and 11.0% in 100 AMX-tolerant controls, respectively. Within HLA-B protein, the S140 present in all cases and demonstrated the strongest association with AMX-SCAR [OR = 53.5, p = 5.18 × 10-4]. Molecular docking results also confirmed the interaction between AMX and S140 of the HLA-B protein, thus eliminating the false-positive results during in association analysis. Conclusion Our findings suggest that genetic susceptibility may be involved in the development of AMX-SCAR in Han Chinese. However, whether the HLA-B variants observed in this study can be used as an effective genetic marker of AMX-induced SCAR still needs to be further explored in larger cohort studies and other ethnic populations.
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Affiliation(s)
- Ting Wang
- Children’s Hospital of Fudan University, Institutes of Biomedical Sciences of Fudan, Shanghai, China
| | - Jin Yang
- Department of Allergy and Immunology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
- Research Center of Allergy and Diseases, Fudan University, Shanghai, China
| | - Fanping Yang
- Department of Allergy and Immunology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
- Research Center of Allergy and Diseases, Fudan University, Shanghai, China
| | - Ye Cheng
- Children’s Hospital of Fudan University, Institutes of Biomedical Sciences of Fudan, Shanghai, China
| | - Zichong Huang
- College of Chemistry, Green Catalysis Center, Zhengzhou University, Zhengzhou, China
| | - Bei Li
- Children’s Hospital of Fudan University, Institutes of Biomedical Sciences of Fudan, Shanghai, China
| | - Linlin Yang
- Department of Pharmacology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, China
| | - Qinghe Xing
- Children’s Hospital of Fudan University, Institutes of Biomedical Sciences of Fudan, Shanghai, China
| | - Xiaoqun Luo
- Department of Allergy and Immunology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
- Research Center of Allergy and Diseases, Fudan University, Shanghai, China
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Elston DM. Letter from the Editor: Ensuring appropriate diversity in clinical trials. J Am Acad Dermatol 2024:S0190-9622(23)03397-2. [PMID: 38185253 DOI: 10.1016/j.jaad.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Dirk M Elston
- Department of Dermatology and Dermatologic Surgery Medical University of South California, Charleston, South Carolina.
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