Antibiotic Drug Use and the Risk of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Population-Based Case-Control Study

The Medication Risk of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis in Asians: The Major Drug Causality and Comparison With the US FDA Label

“…In that study, sulfamethoxazole was identified as the culprit drug of all the SJS/TEN cases after taking cotrimoxazole based on the ALDEN scoring system. However, a study recently observed a strong association between SJS/TEN and trimethoprim alone . A further investigation whether trimethoprim alone would induce SJS/TEN in Asian countries is needed.…”

“…However, a study recently observed a strong association between SJS/TEN and trimethoprim alone. 28 A further investigation whether trimethoprim alone would induce SJS/ TEN in Asian countries is needed. In addition, other antibiotics that are widely used in Asian countries, including quinolones, aminopenicillins, and cephalosporins, also accounted for a considerable number of SJS/TEN cases.…”

Trimethoprim: The overlooked component of trimethoprim‐sulfamethoxazole idiosyncratic adverse drug reactions

“…Interestingly, a recent population-based case-control study identified a strong association between severe cutaneous IADRs with TMP alone, not SMX alone or the combined agent. 15 We propose that a currently unknown proportion of these observed IADRs are in fact due to TMP, adding a significant confounding element that has gone unaccounted for and may inadvertently affect the outcome of studies focused on identifying predictors of risk. Improving the understanding of TMP-SMX IADRs must include defining the contribution of TMP to IADR development.…”

Response: The risk of Stevens‐Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptic drugs: Comment on data sparsity

“…1,2 SJS is a rare disease that is caused mainly by new use of a few specific drugs, of which aromatic antiepileptics by far bear the highest risk of triggering SJS. We previously calculated absolute risks of SJS/toxic epidermal necrolysis in new users of trigger drugs other than antiepileptics of 1-6 cases/100 000 new users (one study not published yet), 3 whereas the absolute risk among new users of aromatic antiepileptics was 20-45 cases/100 000 new users. 4 Thus, the expected relative risk estimates for SJS in association with new antiepileptic use can be expected to be very high, which was also suggested in the comprehensive hospital-based EuroSCAR case-control study, which reported ORs of 72 (95% CI 26-225) for carbamazepine and 26 (95% CI 7.8-90) for phenytoin.…”

“…1,2 The idea behind penalized maximum likelihood estimate is that the method penalizes the likelihood by subtracting a "penalty" from the log-likelihood such that it will shrink the final estimates. 3 The choice of penalty is guided by background information-for example, that large values for the parameter are usually implausible.…”