title: Severe cutaneous adverse reactions related to systemic antibiotics.
abstract: BACKGROUND
  Systemic antibiotics are a major cause of severe cutaneous adverse reactions (SCARs). The selection of alternative antibiotics and management for SCARs patients with underlying infections can be challenging.
  
  
  METHODS
  We retrospectively analyzed 74 cases of SCARs, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP), related to use of systemic antibiotics in Taiwan from January 2006 to January 2012. We analyzed the causative antibiotics, clinical features, organ involvements, and mortality. We also assessed patient tolerability to alternative antibiotics after the development of antibiotic-related SCARs.
  
  
  RESULTS
  The most common causes of SCARs were penicillins and cephalosporins for SJS/TEN and AGEP; glycopeptides for DRESS. Fatality was more frequent in the SJS/TEN group. In patients with SJS/TEN, higher mortality was associated with old age and underlying sepsis before the development of SCARs. The majority of patients with penicillin- or cephalosporin-related SCARs were able to tolerate quinolones, glycopeptides, and carbapenems.
  
  
  CONCLUSIONS
  Complicated underlying conditions and infections may increase mortality in patients with antibiotic-related SCARs. The selection of structurally different alternative drugs is important to avoid recurrence.
authors.affiliation: Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan.
authors.forename: Ying-Fang
authors.initials: YF
authors.lastname: Lin
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Yang
authors.forename: Hu
authors.initials: H
authors.lastname: Sindy
authors.forename: Jing-Yi
authors.initials: JY
authors.lastname: Lin
authors.forename: Chung-Yee
authors.initials: CY
authors.lastname: Rosaline Hui
authors.forename: Yun-Chen
authors.initials: YC
authors.lastname: Tsai
authors.forename: Ting-Shu
authors.initials: TS
authors.lastname: Wu
authors.forename: Ching-Tai
authors.initials: CT
authors.lastname: Huang
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Kao
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Hu
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.forename: Shuen-Iu
authors.initials: SI
authors.lastname: Hung
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Chung
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D015780:Carbapenems / Q000009:adverse effects; D002511:Cephalosporins / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D004802:Eosinophilia; D005260:Female; D006020:Glycopeptides / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects*; D015363:Quinolones / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000209:etiology*; D013624:Taiwan
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D006020:Glycopeptides; D010406:Penicillins; D015363:Quinolones
keywords: SCARs; systemic antibiotics