Riesgo de brotes morbiliformes a medicamentos

Published in Dermatology

Journal Scan / Review · November 14, 2019

The Frequency of Low‐Risk Morbilliform Drug Eruptions Observed in Patients Treated With Different Classes of Antibiotics

International Journal of Dermatology

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• These authors reviewed the available literature to assess the frequency of low-risk morbilliform drug eruption associated with various antibiotics and found the highest rates with anti-staphylococcal penicillins (3%–31.7%.). Aminopenicillins (4.5%–10.1%) and vancomycin (6%–9.3%) also had high rates, although histamine response with vancomycin may inflate the observed rates. Risk with cephalosporins was lower, particularly with third- and fourth-generation agents. Lowest risk was seen with fluoroquinolones, tetracyclines, macrolides, linezolid, and daptomycin.

• Morbilliform drug eruptions may present up to 8 weeks after exposure, and peripheral eosinophilia may be a useful feature to differentiate them from viral exanthem. The rate of morbilliform eruption with trimethoprim–sulfamethoxazole was surprisingly low, and, given its association with severe cutaneous adverse reactions, morbilliform eruption warrants careful examination to rule out a high-risk eruption.

– Caroline K. Crabtree, MD

Abstract

Antibiotics are among the most commonly prescribed medications worldwide but can lead to numerous cutaneous adverse events. Cutaneous adverse drug reactions can range from a common and low-risk morbilliform eruption to severe cutaneous adverse reactions (SCARs) such as toxic epidermal necrolysis. In the hospital setting, patients often start a myriad of new drugs and may be on multiple antibiotics when the dermatologist is consulted. With the current lack of commercially available testing for delayed-type hypersensitivity reactions, etiologic confirmation is challenging. While the Naranjo and other standardized assessment criteria are available, complete scoring is often impossible in hospitalized patients. Further, multiple drugs may have been initiated at the same time point. Therefore, the prevalence of antibiotic-associated drug eruptions often is required to facilitate causality assessments. This review summarizes the prevalence of morbilliform eruptions for the most frequently prescribed antibiotics based upon systematic reviews, retrospective, and prospective analyses, with case series and reports providing other salient details.

International Journal of Dermatology

The Frequency of Low‐Risk Morbilliform Drug Eruptions Observed in Patients Treated With Different Classes of Antibiotics

Int. J. Dermatol 2019 Nov 04;[EPub Ahead of Print], AJ Krispinsky, LB Shedlofsky, BH Kaffenberger

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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