Causative drugs for drug-induced cutaneous reactions in central China: a 608-case analysis

Jun Zhao,Lei Hu,Lihua Zhang,Maosong Zhou,Lichen Gao,Lin Cheng

doi:10.1016/j.abd.2019.01.007

Abstract

BackgroundReports regarding the causative drugs of drug-induced cutaneous adverse reactions in China are indistinct, such that different regions have reported the spectrum of drugs differs substantially in different clinical conditions. ObjectiveTo explore the causative drugs that led to cutaneous reactions. MethodsAdverse drug reaction reports from central China were collected and divided into cutaneous adverse reactions and severe cutaneous adverse reactions groups. Cases were reviewed retrospectively for causative drugs. ResultsThe male:female ratio was equal in both cutaneous adverse reactions and severe cutaneous adverse reactions. In cutaneous adverse reactions (n=482), the highest incidence happened between 51 and 60 years of age and the top three causative drugs were antibiotics (48%), Chinese medicine (16%), and allopurinol (9%). In severe cutaneous adverse reactions (n=126), the highest incidence happened between 41 and 50 years of age and the top three causative drugs were sedative-hypnotics and antiepileptics (39%), antibiotics (22%), and allopurinol (15%). Carbamazepine was the most frequently used single-drug (16/18) in sedative-hypnotics and antiepileptics. β-lactams were the most frequently used antibiotics that induced both cutaneous adverse reactions and severe cutaneous adverse reactions. Study limitationsThe small sample size, retrospective design, collection of cutaneous adverse reactions and severe cutaneous adverse reactions at different time frames and locations, and exclusion of patients taking more than five medications are limitations of the study. ConclusionsGender does not affect cutaneous adverse reactions and severe cutaneous adverse reactions. The top three drugs to induce cutaneous adverse reactions are antibiotics, Chinese medicine, and allopurinol, while those that triggered severe cutaneous adverse reactions are sedative-hypnotics and antiepileptics, antibiotics, and allopurinol. Carbamazepine is the most frequent single drug that induces severe cutaneous adverse reactions. β-lactams are the most frequently used antibiotics that induce both cutaneous adverse reactions and severe cutaneous adverse reactions.

Highlights

Drug eruption is a symmetric cutaneous reaction that may occur when patients are taking medicines
Four hundred and eighty two cutaneous adverse reactions (CARs) patients admitted to Wuhan No 1 Hospital from 2010 and 2011 and 126 severe cutaneous adverse reactions (SCARs) patients admitted to Xiangya Hospital from 2009 to 2014 were assessed (Table 1)
In the single-medicine use group, the most frequent drugs were antibiotics (48%, 201/420), followed by Chinese medicine (16%, 66/420) and allopurinol (9%, 38/420). These were followed by non-steroidal antiinflammatory drugs (NSAIDs), sedative hypnotic antiepileptic drugs, nitroimidazole, antihypertensives and lipid-modifying agents, serums and vaccines, digestive system drugs, biological agents, antifungals, antithyroid preparations, and antiviral drugs

Summary

Introduction

Drug eruption is a symmetric cutaneous reaction that may occur when patients are taking medicines It is known as drug-induced cutaneous adverse reactions (CARs), drug dermatitis, or dermatitis medicamentosa. Taking Stevens-Johnsons syndrome (SJS) and toxic epidermal necrolysis (TEN) for example, around 5.76 cases occur out of one million people per year.3---5. In cutaneous adverse reactions (n = 482), the highest incidence happened between 51 and 60 years of age and the top three causative drugs were antibiotics (48%), Chinese medicine (16%), and allopurinol (9%). In severe cutaneous adverse reactions (n = 126), the highest incidence happened between 41 and 50 years of age and the top three causative drugs were sedative-hypnotics and antiepileptics (39%), antibiotics (22%), and allopurinol (15%). Carbamazepine was the most frequently used single-drug (16/18) in sedativehypnotics and antiepileptics. ␤-lactams were the most frequently used antibiotics that induced both cutaneous adverse reactions and severe cutaneous adverse reactions

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