An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia

Choon, Siew Eng; Lai, Nai Ming

doi:10.4103/0378-6323.102367

Cited by 58 publications

(94 citation statements)

References 14 publications

(45 reference statements)

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“…2,8 Previous local studies have reported an incidence of 0.86%. 9 The low prevalence in this study may be attributed to the possibility that mild cases of ACDR not requiring dermatology consultation may not have been referred and hence not captured in this study.…”

Section: Discussionmentioning

confidence: 56%

“…An earlier study in Malaysia showed a lower mean age. 9 This is probably because the paediatric population was excluded from the present study. The relationship between age and ACDR remains debatable as studies have shown controversial results.…”

Section: Discussionmentioning

confidence: 79%

“…Other studies have also found similar results. 9,16 A local study by Ding found that clotrimoxazole was the commonest antibiotic to cause ACDR. 9 Hence the decision to initiate antibiotic treatment should be justified to prevent unnecessary morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…This is quite similar to both local studies and those from different parts of the world. 2,9 Skin reactions are the most common clinical manifestations of ACDR due to high immunogenic activity in the skin. 14 There are not many previous studies that looked at the relationship between duration of drug intake and onset of ACDR.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier local studies show a higher range at 40.6%. 9 Hospital-based studies are expected to detect more cases of severe ACDR compared with primary care, as they are referral centres to which patients are referred for close monitoring and management as severe reactions can cause fatalities. Antibiotics are the most common group of drugs responsible for ACDR in the present study (74.6%).…”

Section: Discussionmentioning

confidence: 99%

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Common adverse cutaneous drug reaction patterns and the causative drugs in Malaysia

Talib¹,

Leelavathi

Hamzah

2015

South African Family Practice

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Background:Patients with adverse cutaneous drug reactions (ACDRs) are frequently referred from primary care to tertiary centres for further management. This causes a loss of information regarding ACDRs as these patients discontinue primary care follow-up upon referral to tertiary care. The aim of this study is to determine the prevalence and characteristics of ACDR, and to use this valuable information to enhance awareness of primary care physicians regarding this condition. Method: A retrospective cross-sectional study on ACDR was done at the Dermatology Clinic, Kuala Lumpur General Hospital from January 2009 to December 2010. Results: The prevalence of ACDR was 0.2%. The majority of patients (71.6%) were below 59 years of age. ACDR commonly (55.2%) occurs within hours to days of drug ingestion and is of mild to moderate severity (74.6%). About 27.6% of affected patients took 1 to 5 drugs concurrently. Common cutaneous manifestation of ACDR includes maculopapular rash (22.4%) and Stevens-Johnson syndrome (SJS, 9.7%). Antibiotics (36.6%), traditional and complementary medicine (TCM, 17.9%) and analgesics (13.4%) were the most frequent agents responsible for ACDR. Conclusion:The prevalence of ACDR in this study is low and the majority were of mild to moderate severity. The most common cutaneous manifestation was a maculopapular reaction and Stevens-Johnson syndrome. Antibiotics were the commonest causative agent for ACDR followed by traditional and complementary medicine and analgesics. Patients presenting with cutaneous disorders in primary care should be assessed for possible ACDR. A detailed drug history, time of initiation and duration of drug consumption are all valuable information required for an accurate diagnosis and proper evaluation of ACDR. It is hoped that the findings of this study will facilitate early recognition of ACDR followed by identification and elimination of any possible offending drugs that may be prescribed in primary care practice.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Common adverse cutaneous drug reaction patterns and the causative drugs in Malaysia

Talib¹,

Leelavathi

Hamzah

2015

South African Family Practice

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Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

2023

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ImportanceAntibiotics are an important risk for Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), which are the most severe types of drug hypersensitivity reaction with a mortality rate up to 50%. To our knowledge, no global systematic review has described antibiotic-associated SJS/TEN.ObjectiveTo evaluate the prevalence of antibiotics associated with SJS/TEN worldwide.Data SourcesThe MEDLINE and Embase databases were searched for experimental and observational studies that described SJS/TEN risks since database inception to February 22, 2022.Study SelectionIncluded studies adequately described SJS/TEN origins and specified the antibiotics associated with SJS/TEN.Data Extraction and SynthesisTwo reviewers (E.Y.L. and C.K.) independently selected the studies, extracted the data, and assessed the risk of bias. A meta-analysis using a random-effects model was performed in the studies that described patient-level associations. Subgroup analyses were performed to explore the heterogeneity. The risk of bias was assessed using the Joanna Briggs Institute checklist, and the certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.Main Outcomes and MeasuresPrevalence of antibiotic-associated SJS/TEN was presented as pooled proportions with 95% CIs.ResultsAmong the 64 studies included in the systematic review, there were 38 studies that described patient-level associations; the meta-analysis included these 38 studies with 2917 patients to determine the prevalence of single antibiotics associated with SJS/TEN. The pooled proportion of antibiotics associated with SJS/TEN was 28% (95% CI, 24%-33%), with moderate certainty of evidence. Among antibiotic-associated SJS/TEN, the sulfonamide class was associated with 32% (95% CI, 22%-44%) of cases, followed by penicillins (22%; 95% CI, 17%-28%), cephalosporins (11%; 95% CI, 6%-17%), fluoroquinolones (4%; 95% CI, 1%-7%), and macrolides (2%; 95% CI, 1%-5%). There was a statistically significant heterogeneity in the meta-analysis, which could be partially explained in the subgroup analysis by continents. The overall risk of bias was low using the Joanna Briggs Institute checklist for case series.Conclusion and RelevanceIn this systematic review and meta-analysis of all case series, antibiotics were associated with more than one-quarter of SJS/TEN cases described worldwide, and sulfonamide antibiotics remained the most important association. These findings highlight the importance of antibiotic stewardship, clinician education and awareness, and weighing the risk-benefit assessment of antibiotic choice and duration.

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Allopurinol Use and Risk of Fatal Hypersensitivity Reactions

et al. 2015

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An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia

Cited by 58 publications

References 14 publications

Common adverse cutaneous drug reaction patterns and the causative drugs in Malaysia

Common adverse cutaneous drug reaction patterns and the causative drugs in Malaysia

Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Allopurinol Use and Risk of Fatal Hypersensitivity Reactions

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