Macrolide Allergic Reactions

Abstract

Macrolides are antimicrobial agents that can be used to treat a variety of infections. Allergic reactions to macrolides occur infrequently but can include minor to severe cutaneous reactions as well as systemic life-threatening reactions such as anaphylaxis. Most reports of allergic reactions occurred in patients without prior exposure to a macrolide. Cross-reactivity among macrolides may occur due to the similarities in their chemical structures; however, some published literature indicates that some patients can tolerate a different macrolide. Most published reports detailed an allergic reaction to erythromycin. Desensitization protocols to clarithromycin and azithromycin have been described in the literature. The purpose of this article is to summarize macrolide-associated allergic reactions reported in published literature. An extensive literature search was conducted to identify publications linking macrolides to hypersensitivity reactions.

Stevens‐Johnson syndrome and toxic epidermal necrolysis associated with the use of macrolide antibiotics: a review of published cases

“…1 This group of antibiotics includes 14-membered lactones (erythromycin, roxithromycin, clarithromycin), 15membered lactones (azithromycin), ketolides (telithromycin), and 18-membered lactones (fidaxomicin). 2,3 Fidaxomicin is indicated for the treatment of Clostridium difficile-associated diarrhea in adults, while all other macrolides may be used in the treatment of a variety of infections including respiratory tract infections, skin and soft tissue infections, pelvic inflammatory disease, as well as to eradicate Helicobacter pylori. 1,2 In several studies, macrolides were identified as one of the classes of antibiotics which are associated with the occurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, formally known as Lyell syndrome).…”

“…2,3 Fidaxomicin is indicated for the treatment of Clostridium difficile-associated diarrhea in adults, while all other macrolides may be used in the treatment of a variety of infections including respiratory tract infections, skin and soft tissue infections, pelvic inflammatory disease, as well as to eradicate Helicobacter pylori. 1,2 In several studies, macrolides were identified as one of the classes of antibiotics which are associated with the occurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, formally known as Lyell syndrome). 4,5 SJS and TEN (SJS/TEN) are rare acute severe, potentially life-threatening, mucocutaneous hypersensitivity reactions characterized by epidermal necrosis and detachment.…”

“…9 Global clinical and financial burden of SJS/ TEN is considerable, resulting in prolonged hospital stays, mortality, and considerable long-term multisystem physical and mental health morbidity. 10 As previous review articles have mostly focused on adverse effects of macrolide antibiotics in general 1,11 and allergic reactions caused by macrolide antibiotics, 2 the aim of this review was to investigate and consolidate information regarding the characteristics of published cases of SJS/TEN suspected to be associated with the use of macrolide antibiotics in order to give The following data were extracted for each described case: demographics (age, gender), medical history, information about the macrolide antibiotic suspected to be associated with the occurrence of SJS/TEN (generic name of the drug, dosage, indication), concomitant medications, diagnosis of the reaction (SJS, TEN, SJS/TEN overlap), severity-of-illness score for toxic epidermal necrolysis (SCORTEN) if reported, diagnostic investigations (e.g., physical examination, skin biopsy, patch test), time to onset of the reaction (from the first dose of a macrolide antibiotic to the first symptoms of SJS/TEN, including prodromal symptoms), clinical manifestations, complications, sequelae, treatment, length of stay in hospital, outcome, algorithm for assessment of drug causality for epidermal necrolysis (ALDEN) if reported, and Naranjo score 12 for assessing the likelihood of causality of the association described if reported (the adverse drug reaction is assigned to a probability category based on the total Naranjo score as follows: "definite" ≥9, "probable" 5-8, "possible" 1-4, and "doubtful" ≤0).…”

“…Macrolides are one of the most commonly prescribed antibiotics worldwide which are classified based on the number of atoms in the lactone ring 1 . This group of antibiotics includes 14‐membered lactones (erythromycin, roxithromycin, clarithromycin), 15‐membered lactones (azithromycin), ketolides (telithromycin), and 18‐membered lactones (fidaxomicin) 2,3 . Fidaxomicin is indicated for the treatment of Clostridium difficile ‐associated diarrhea in adults, while all other macrolides may be used in the treatment of a variety of infections including respiratory tract infections, skin and soft tissue infections, pelvic inflammatory disease, as well as to eradicate Helicobacter pylori 1,2 …”

Case report: SARS‐CoV ‐2‐induced urticaria or just a concomitance?

“…Hypersensitivity reactions resulting from macrolide use occur infrequently (0.4%-3%). 6 It was hypothesized that the skin rash in macrolides use could result from infection-mediated immunomodulation or due to an altered drug metabolism caused by the disease. 7 Incidence of hypersensitivity reactions with cephalosporins is reported to be 1% to 3%.…”