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

Abstract

Macrolides are one of the most commonly prescribed antibiotics. In several studies, their use was associated with the occurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). This review aimed to explore and summarize available cases of SJS/TEN suspected to be associated with the use of macrolide antibiotics reported in the literature. Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, and Serbian Citation Index (SCIndeks). Twenty-five publications describing a total of 27 patients were included. Cases of SJS/TEN which satisfied inclusion criteria were found for azithromycin (n = 11), clarithromycin (n = 7), erythromycin (n = 5), roxithromycin (n = 2), and telithromycin (n = 2). The age of the patients ranged from 2 to 77 years (median: 29 years). There were 14 female (51.9%) and 13 male (48.1%) patients. SJS was diagnosed in 16 patients (59.3%), TEN in 10 patients (37.0%), and SJS/TEN overlap in one patient (3.7%). Time to onset of the first symptoms ranged from 1 to 14 days (median: 3 days). All patients received some form of supportive and symptomatic care. Systemic corticosteroids were reported to be administered in 12 patients (44.4%) and intravenous immunoglobulin in five patients (18.5%). Three patients (11.1%) died. Considering that SJS/TEN is a severe and potentially life-threatening reaction, physicians should be aware that they could be adverse effects of macrolide antibiotics and keep in mind that prompt recognition of SJS/TEN and discontinuation of the culprit drug in combination with supportive care is essential.

Culprit Medications and Risk Factors Associated with Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Population-Based Nested Case–Control Study

“…We also confirm the high risk associated with COX-2 inhibitors, sulfonamides, cephalosporines, and carbamazepine, previously reported [12,22]. Clindamycin, amoxicillin, amoxicillin-clavulanate, ciprofloxacin, roxithromycin, ceftriaxone, and terbinafine, for which we found possible associations (ALDEN scores: 2-3) had been associated with case reports of SJS/TEN [23][24][25][26][27][28][29][30].…”

Erythema Multiforme Major Associated With Community-Acquired Pneumonia: Lessons From a Case Report

“…Azithromycin, a potent and well-tolerated semisynthetic macrolide from erythromycin, is the most prescribed antibiotic in China. Macrolide antibiotics have been reported to induce severe hypersensitivity related cutaneous reactions, which are rare ADRs (38)(39)(40). Pediatric cases have been found to develop SJS associated with azithromycin and reactivation of HSV infections (41).…”

</title> <original_language_title>Актуальные вопросы патогенетического лечения болезни Фабри в Российской Федерации</original_language_title> </titles> <contributors> <person_name sequence='first' contributor_role='author'> <given_name>S.</given_name> <surname>Moiseev</surname>

“…При назначении макролидов возможно развитие таких серьезных НЛР, как синдром Стивенса-Джонсона и токсический эпидермальный некролиз [95]. В 2021 году был опубликован обзор опубликованных описаний клинических случаев возникновения синдрома Стивенса-Джонсона/токсического эпидермального некролиза на фоне применения макролидов, в который были включены 25 публикаций [96]. Эти НЛР были зарегистрированы при лечении азитромицином (n=11), кларитромицином (n=7), эритромицином (n=5), рокситромицином (n=2) и телитромицином (n=2).…”