Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis

A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population

“…Many other less prescribed drugs have more ADR than paracetamol. In contrast to SCAR and EuroSCAR, [25,29] we found only one case of SJS with piroxicam. Drug utilization studies of NSAIDs from India show the less use of piroxicam as compared to paracetamol, ibuprofen and diclofenac.…”

“…There is no increased risk with diclofenac, salicylates and pyrazolone derivatives. [29] EuroSCAR study found weak association of paracetamol with SJS. [25] Paracetamol is confounded by its use to treat nonspecific symptoms such as fever or pain, the early signs of the adverse reaction or infection both.…”

“…[24,27] SCAR study has reported association of SJS/TEN with phenobarbitone, carbamazepine, phenytoin and sodium valproate. [29] Subsequent EuroSCAR study did not find significant risk with sodium valproate. [25] The association of sodium valproate seems to be confounded by concomitant use of other anti-epileptic drugs.…”

“…However, severe cutaneous adverse reactions (SCAR) study has found significant increase risk of SJS with sulfa drugs, aminopenicillins, quinolones and cephalosporins after ruling out recent infections as a confounding factor. [29] In EuroSCAR study, nevirapine is the leading culprit in HIV-positive patients. [25] Though the total reported cases with nevirapine are 11 (2.83%) in our study; this drug should be monitored because of its widespread use as a first-line anti-retroviral drug in India.…”

Fever with rash in a child in India

“…Other drugs include antibiotics like sulphonamides, penicillins, and fluoroquinolones as well as NSAIDs. [71,72] Another severe drug eruption includes leucocytoclastic vasculitis, characterized by blanching erythematous macules, replaced later by palpable purpura. Fever, myalgias, arthritis, and abdominal pain may be present.…”