trimethoprim--sulfamethoxazole-drug-combination and Dermatitis--Exfoliative

Topics: Anti-Infective Agents; Dermatitis, Exfoliative; Female; Humans; Hypersensitivity, Immediate; Immune Tolerance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Dermatitis, Exfoliative; Humans; Male; Middle Aged; Psoriasis; Trimethoprim, Sulfamethoxazole Drug Combination

Various types of cutaneous drug eruptions and the incriminating drugs were analyzed in 50 children and adolescents up to 18 years of age (34 or 65% boys, 16 or 32% girls). Thirteen (26%) patients had a maculopapular rash, 11 (22%) a fixed drug eruption (FDE), 10 erythema multiforme (EM), 6 (12%) toxic epidermal necrolysis (TEN), 5 (10%) Stevens-Johnson syndrome (SJS), 3 (6%) urticaria, and 2 (4%) erythroderma. The incubation period for maculopapular rashes, SJS and TEN due to commonly used antibiotics and sulfonamides was short, a few hours to two to three days, reflecting reexposure, and for drugs used sparingly such as antiepileptics and antituberculosis agents, was approximately one week or more, suggesting a first exposure. Antibiotics were responsible for cutaneous eruptions in 27 patients, followed by antiepileptics in 17, analgin in 4, and metronidazole and albendazole in 1 each. Cotrimoxazole, a combination of sulfamethoxazole and trimethoprim, was the most common antibacterial responsible for eruptions (11 patients), followed by penicillin and its semisynthetic derivatives (8 patients), sulfonamide alone (3 patients), and other antibiotics (4 patients). Antiepileptics were the most frequently incriminated drugs in EM, TEN, and SJS. The role of systemic corticosteroids in the management of SJS and TEN is controversial. We administered prednisolone or an equivalent corticosteroid 2 mg/kg/day for 7 to 14 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Anti-Bacterial Agents; Anticonvulsants; Antitubercular Agents; Case-Control Studies; Child; Child, Preschool; Dermatitis, Exfoliative; Dipyrone; Drug Eruptions; Erythema Multiforme; Female; Humans; India; Infant; Male; Penicillins; Prednisolone; Prospective Studies; Stevens-Johnson Syndrome; Sulfonamides; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria

A variety of skin reactions have been associated with the use of sulfonamides. Most of the reactions are uneventful and abate with drug discontinuation. Rare but severe skin reactions can occur and include the Stevens-Johnson syndrome and exfoliative dermatitis. Dermal reactions appear to be the most commonly reported adverse effect in children. Drug continuance following the development of a mild skin rash may be associated with the development of a more severe dermal reaction. This report summarizes a case involving a six-year-old white girl who developed exfoliative dermatitis confined to the feet following a course of oral trimethoprim/sulfamethoxazole (TMP/SMX) for otitis media. Exfoliation is an uncommon cutaneous manifestation following sulfonamide use. Although usually a generalized process, it is unusual to find it confined to the feet. Unfortunately there is no useful diagnostic method that could specifically elucidate the cause of a dermatologic eruption. Available evidence suggest that TMP/SMX was the probable cause of our patient's rash. Adjunctive antihistamines and corticosteroids are often useful when pruritus is present. Severe reactions require vigorous supportive treatment.

Topics: Child; Dermatitis, Exfoliative; Female; Humans; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

A patient with acquired immunodeficiency syndrome (AIDS) developed rash, fever, neutropenia, and elevated liver function tests during an initial course of trimethoprim-sulfamethoxazole (TMP-SMX) therapy. Upon reexposure to the drug, the patient experienced a severe anaphylactoid reaction associated with pulmonary edema and rhabdomyolysis. Reactions associated with TMP-SMX rechallenge in this patient population have been previously reported but have not been associated with this degree of severity. TMP-SMX therapy should be instituted with extreme caution in patients with AIDS who have demonstrated a prior hypersensitivity reaction to the drug.

Topics: Acquired Immunodeficiency Syndrome; Adult; Dermatitis, Exfoliative; Drug Combinations; Drug Hypersensitivity; Fever; Humans; Hypersensitivity, Delayed; Male; Pneumonia, Pneumocystis; Pulmonary Edema; Rhabdomyolysis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole may cause life-threatening reactions and even death, but such reactions are rare and do not detract from its usefulness. As with any therapy, however, caution should be observed in its use in children, and especially in the elderly.

Topics: Anti-Infective Agents; Child; Dermatitis, Exfoliative; Drug Combinations; Humans; Male; Nephritis, Interstitial; Pulmonary Fibrosis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination