title: Drug-induced Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS-TEN overlap: a multicentric retrospective study.
abstract: BACKGROUND
  Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare immune-mediated severe cutaneous adverse reactions with incidence rate of 0.05 to 2 persons per million populations per year. Drugs are the most commonly implicated in 95% of cases.
  
  
  OBJECTIVE
  To audit the causative drugs, clinical outcome, and cost of management in SJS, TEN, and SJS-TEN overlap.
  
  
  METHODS
  Tertiary care hospitals-based multicentric retrospective study (case series).
  
  
  METHODS
  Indoor case papers of SJS, TEN, and SJS-TEN overlap admitted between January 2006 and December 2009 in four tertiary care hospitals of Gujarat were scrutinized. Data were collected for demographic information, causative drugs, investigations, treatment given, duration of hospital stay, time interval between onset of symptoms and drug intake, clinical outcome, and complications. Data were analyzed to find out proportion of individual drugs responsible, major complications, and clinical outcome in SJS, TEN, and SJS-TEN overlap. Total cost of management was calculated by using cost of drugs, investigations, and consumables used during entire hospital stay.
  
  
  METHODS
  One-way Analysis of Variance followed by Tukey-Kramer multiple comparison test was used for comparison of incubation period, duration of hospital stay, and cost of management.
  
  
  RESULTS
  Antimicrobials (50%), nonsteroidal anti-inflammatory drugs (22.41%), and antiseizure drugs (18.96%) were the most commonly associated groups. Nevirapine (28.12%) was the most common drug. Antiseizure drugs were more often associated with serious form of adverse reaction (TEN: 81.8%) than other drugs. Duration of hospital stay (20.6 vs 9.7 days) and cost of management (7,910/- vs 2,460/-) were significantly higher in TEN than SJS (P=0.020 and P<0.001, respectively). Time duration between drug intake and onset of symptoms (17.7 vs 27.5 days) was nonsignificantly lower in TEN as compared with SJS. Secondary infection (28.12%) was the most common complication noted. Mortality rate was 15.6% among all cases; 9% in SJS and 26.7% in TEN.
  
  
  CONCLUSIONS
  Antimicrobial drugs are the most commonly implicated drugs and cost of managing these adverse drug reactions is higher than other serious ADRs.
authors.affiliation: Department of Pharmacology, Government Medical College, Bhavnagar, India.
authors.forename: M
authors.initials: M
authors.lastname: Barvaliya
authors.forename: J
authors.initials: J
authors.lastname: Sanmukhani
authors.forename: T
authors.initials: T
authors.lastname: Patel
authors.forename: N
authors.initials: N
authors.lastname: Paliwal
authors.forename: H
authors.initials: H
authors.lastname: Shah
authors.forename: C
authors.initials: C
authors.lastname: Tripathi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D017678:Sex Distribution; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced* / Q000150:complications / Q000191:economics / Q000628:therapy; D055815:Young Adult