trimethoprim--sulfamethoxazole-drug-combination and Exanthema

Nevirapine and cotrimoxazole are associated with hematologic toxicities and skin-rash. Safety of their concurrent use for prophylaxis over extended periods among HIV-exposed uninfected infants has not been previously assessed.. Secondary data analysis of the 'HIV Prevention Trials Network-046 protocol' (version 2.0), a phase-III, randomized, placebo-controlled trial that assessed efficacy and safety of nevirapine prophylaxis against breast milk transmission of HIV-1.. Trial infants received 6-month study nevirapine/placebo, and standard-of-care peripartum single-dose nevirapine+/- zidovudine 'tail', and cotrimoxazole prophylaxis from 6 weeks through breastfeeding cessation. Adverse events were monitored using United States Division of AIDS Toxicity Tables (2004). Risk of neutropenia, anemia and skin-rash in the cotrimoxazole + nevirapine and the cotrimoxazole + placebo groups were compared using negative-binomial regression.. Incidence of neutropenia and/or anemia, and skin-rash was highest during the first 6 weeks of life and declined, thereafter, regardless of study group. Time to first adverse event after 6 weeks was similar in cotrimoxazole + nevirapine and cotrimoxazole + placebo groups: hazard ratio (95% confidence interval) was 1.26 (0.96-1.66) for neutropenia and/or anemia (all grades), 1.27 (0.80-2.03) for neutropenia and/or anemia (grade ≥3) and 1.16 (0.46-2.90) for skin-rash (grade ≥2). There were no statistically significant differences in immediate (6 weeks-6 months) and long-term (6-12 months) adverse event risk among infants on cotrimoxazole + nevirapine versus cotrimoxazole + placebo.. Extended nevirapine and cotrimoxazole prophylaxis through 6 months of age among HIV-exposed uninfected infants did not appear to increase the immediate or long-term risk of neutropenia, anemia or skin-rash. Concurrent use beyond 6 months, however, needs to be evaluated.

Topics: Adult; Anemia; Anti-HIV Agents; Blotting, Western; Breast Feeding; Drug Administration Schedule; Drug Eruptions; Exanthema; Female; HIV Seropositivity; HIV-1; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Milk, Human; Neutropenia; Nevirapine; Pregnancy; Risk Factors; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Uganda

In a randomized double blind placebo controlled trial, HIV sero-positive patients with CD4+ cell count less than 200 x 10(6)/l or an AIDS diagnosis were evaluated for drug reactions to trimethoprim-sulphamethoxazole (TMP-SMX) during treatment, including pretreatment, with N-acetylcysteine (NAC) 800 mg daily or placebo. TMP-SMX (one double-strength tablet containing 160 mg of trimethoprim and 800 mg of sulphamethoxazole) was given three times weekly as primary Pneumocystis carinii (PCP) prophylaxis. Thirty percent (n = 15) of the patients experienced adverse reactions 8-20 (mean 12.7) days after starting with TMP-SMX. At entry, low cysteine and glutathione levels in plasma were found in the HIV-positive patients. Age, sex, CD4+ count, plasma cysteine and glutathione levels were not risk factors for adverse reactions to TMP-SMX. However, concomitant therapy with nucleoside analogues was associated with increased risk for TMP-SMX reactions. Oral NAC 800 mg daily was well tolerated, but replenished neither cysteine nor glutathione levels in plasma. NAC 800 mg/day did not significantly decrease the risk of adverse reactions to TMP-SMX in this study, and could thus not be recommended for this purpose. A prolonged pretreatment period and/or higher dose of NAC may be necessary for clinical effect.

Topics: Acetylcysteine; Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Cysteine; Exanthema; Female; Fever; Glutathione; Humans; Male; Pneumocystis; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (TMP-SMX) hypersensitivity reaction, ranging from circulatory shock to aseptic meningitis and respiratory failure, is a potentially life-threatening condition with dermatologic relevance.. To describe the mucocutaneous findings and clinical features of TMP-SMX hypersensitivity reaction.. This was a retrospective case series study of 7 patients who developed a characteristic rash, hemodynamic changes, and end-organ dysfunction after treatment with TMP-SMX at a large university hospital system during January 2013 to March 2022.. Treatment with TMP-SMX within 2 weeks of the reaction.. Descriptions of the condition, including the demographic information of the affected population, the reaction timeline, and mucocutaneous and clinical features.. The cohort comprised 7 patients (median [range] age, 20 [15-66] years; 4 female and 3 male). The most common mucocutaneous findings were generalized sunburn-like erythema without scale, conjunctivitis, and mild facial and acral edema. Three patients had previous exposure to TMP-SMX and developed symptoms in 1 day or less, while those without prior exposure presented from 4 to 11 days after drug initiation. Among the 7 patients, 6 had fever, 7 had hypotension, and 7 had tachycardia. All patients had lymphopenia and evidence of end-organ dysfunction with either kidney or liver involvement. Median (range) time to resolution was 72 (48-96) hours.. This retrospective case series indicates that SCoRCH (sudden conjunctivitis, lymphopenia, and rash combined with hemodynamic changes) should be considered in the differential diagnosis of patients presenting with acute generalized sunburn-like erythema, conjunctivitis, systemic symptoms, and hemodynamic changes in the setting of recent TMP-SMX use.

Topics: Adult; Exanthema; Female; Humans; Hypersensitivity; Lymphopenia; Male; Multiple Organ Failure; Retrospective Studies; Sunburn; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Sudden conjunctivitis, lymphopenia, and rash combined with hemodynamic changes (SCoRCH) is a recently described hypersensitivity reaction to trimethoprim-sulfamethoxazole. To date, only 1 case of histologic findings in SCoRCH has been reported, revealing a superficial perivascular dermatitis. In this article, we present a 53-year-old woman with a four-day history of a widespread, confluent, erythematous, and dusky rash after exposure to trimethoprim-sulfamethoxazole. Histologic examination revealed a vacuolar interface dermatitis with several apoptotic keratinocytes at multiple levels of the epidermis, similar to an erythema multiforme-like presentation. As described in SCoRCH, our patient's clinical findings rapidly improved within 48 hours of presentation without treatment. This case adds to the current literature by identifying a newly described histopathological presentation of SCoRCH.

Topics: Conjunctivitis; Dermatitis; Exanthema; Female; Humans; Lymphopenia; Middle Aged; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

A 56-year-old Chinese woman with previous disseminated mycobacterium avium complex infection and recurrent cervical abscesses from

Topics: Adult; Anti-Bacterial Agents; Autoantibodies; Drug Hypersensitivity Syndrome; Eosinophilia; Exanthema; Female; Humans; Immunologic Deficiency Syndromes; Interferon-gamma; Middle Aged; Mycobacterium Infections, Nontuberculous; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole, otherwise known as Bactrim or Septra, is a commonly prescribed antibiotic for soft tissue infections. Drug-induced thrombocytopenia is a rare but serious adverse reaction to sulfonamide antibiotics like Bactrim/Septra. A 34-year-old active duty marine male with no significant past medical history presented with a chief complaint of a rash on his lower extremities. The patient stated that 2 weeks earlier, he was prescribed Bactrim for cellulitis at the site of a new tattoo. The intern noted a petechial rash that was pathognomonic for thrombocytopenia. Laboratory testing confirmed the patient's thrombocytopenia with platelets of 2,000/μL on initial complete blood count, without pancytopenia or other coagulopathies. The blood smear indicated a profound lack of platelets but otherwise normal cell counts and morphology. In the emergency department, the patient was typed and crossed, platelets were ordered, and hematology-oncology was consulted. Once admitted to the internal medicine ward, he was administered glucocorticoids as well as platelet transfusions. He was monitored for 3 days and discharged with a diagnosis of resolved drug-induced thrombocytopenia. This case illustrates the importance of conducting a thorough review of systems and physical examination in stable and otherwise healthy patients. In this case, the seemingly benign rash was one of the only clinical signs of severe thrombocytopenia, with a high risk of spontaneous bleeding in clinically significant organ systems. It is important to recognize immune thrombocytopenic purpura as a potential complication of Bactrim/Septra, as this antibiotic is widely used by military providers in operational settings.

Topics: Adult; Anti-Bacterial Agents; Exanthema; Humans; Male; Purpura, Thrombocytopenic, Idiopathic; Tattooing; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Anti-Bacterial Agents; Diagnosis, Differential; Drug Hypersensitivity Syndrome; Exanthema; Fever; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Drug Hypersensitivity Syndrome; Exanthema; Fever; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

After being treated for venous insufficiency and malleolus ulceration, this patient woke up covered in itchy, painful plaques. What was the connection between the 2?

Topics: Adult; Ankle Injuries; Exanthema; Glucocorticoids; Histamine Antagonists; Humans; Male; Naproxen; Prednisone; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Varicose Ulcer; Venous Insufficiency

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; CD4 Lymphocyte Count; Chickenpox; Child, Preschool; Clindamycin; Drug Therapy, Combination; Exanthema; Floxacillin; Herpesvirus 3, Human; HIV Infections; HIV-1; Humans; Male; Pneumonia, Viral; Trimethoprim, Sulfamethoxazole Drug Combination

The histopathological features of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome remain poorly characterized.. To better characterize the histopathological features of DRESS syndrome, and define the phenotype of the effector cells in the skin and compare it with maculopapular rash (MPR).. We conducted a retrospective study on 50 skin biopsies from patients with DRESS syndrome (n = 36). Histopathological and immunophenotypical features were studied and compared with a series of MPRs (n = 20).. Foci of interface dermatitis, involving cutaneous adnexae, were frequently seen in cases of DRESS. Eosinophils were seen in only 20% of cases and neutrophils in 42%. Eczematous (40%), interface dermatitis (74%), acute generalized exanthematic pustulosis-like (20%) and erythema multiforme-like (24%) patterns were observed. The association of two or three of these patterns in a single biopsy was significantly more frequent in cases of DRESS than in a series of nondrug-induced dermatoses (P < 0.01), and appeared to be more marked in DRESS syndrome with severe cutaneous lesions (P = 0.01) than in less severe cases of DRESS and MPR. A higher proportion of CD8(+) and granzyme B(+) lymphocytes was observed in cases of DRESS with severe cutaneous eruptions (erythroderma and/or bullae). Atypical lymphocytes were found in 28% of biopsies, and expressed CD8 in most cases; a cutaneous T-cell clone was rarely found (6%).. The histopathology of DRESS syndrome highlights various associated inflammatory patterns in a single biopsy. Cutaneous effector lymphocytes comprise a high proportion of polyclonal CD8(+) granzyme B(+) T lymphocytes.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Allopurinol; Anti-Bacterial Agents; B-Lymphocytes; Carbamazepine; Drug Hypersensitivity Syndrome; Exanthema; Female; Gout Suppressants; Humans; Immunohistochemistry; Male; Middle Aged; Minocycline; Phenotype; Retrospective Studies; Sulfasalazine; T-Lymphocytes; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Anti-Infective Agents; Child; Diagnosis, Differential; Drug Eruptions; Exanthema; Humans; Male; Recurrence; Self Medication; Trimethoprim, Sulfamethoxazole Drug Combination

A 45-year-old man presented with follicular exanthema in his lower limbs, alternating bowel habits and significant weight loss. His medical history included seronegative arthritis, bipolar disease and an inconclusive diagnostic laparoscopy. Diagnostic work up revealed microcytic anaemia and multivitamin deficiency. Skin biopsy of the exanthema suggested scurvy. Owing to these signs of malabsorption, upper endoscopy with duodenal biopsies was performed, exhibiting villous atrophy and extensive periodic acid-Schiff-positive material in the lamina propria, therefore diagnosing Whipple's disease (WD). After starting treatment with ceftriaxone and co-trimoxazole, an impressive recovery was noted, as the wide spectrum of malabsorption signs quickly disappeared. After a year of antibiotics, articular and cutaneous manifestations improved, allowing the patient to stop taking corticosteroids and antidepressants. This truly unusual presentation reflects the multisystemic nature of WD, often leading to misdiagnosis of other entities. Scurvy is a rare finding in developed countries, but its presence should raise suspicion for small bowel disease.

Topics: Anti-Bacterial Agents; Biopsy; Ceftriaxone; Diagnostic Errors; Exanthema; Follow-Up Studies; Humans; Middle Aged; Scurvy; Skin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

A 24-year-old active duty soldier was evacuated from Afghanistan to the United States after persistent upper respiratory tract infection. His course was complicated by an exfoliative rash, diffuse muscle aches, and elevated creatine kinase following trimethoprim-sulfamethoxazole exposure that persisted despite withdrawal of the medication. Dermatomyositis was strongly considered, but the patient had a negative muscle biopsy and had positive serologies for acute Epstein-Barr virus infection. We present a case of acute Epstein-Barr virus infection and possible trimethoprim-sulfamethoxazole reaction mimicking dermatomyositis.

Topics: Afghan Campaign 2001-; Anti-Infective Agents; Creatine Kinase; Dermatomyositis; Diagnosis, Differential; Drug Eruptions; Exanthema; Humans; Infectious Mononucleosis; Male; Military Personnel; Myalgia; Pharyngitis; Rhabdomyolysis; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Young Adult

Treatment of hairy cell leukemia (HCL) with cladribine induces durable remissions. Common toxicities are myelosuppression and immunosuppression with low counts of CD4 + T cells. Skin rash (SR) is seldom described. We collected clinical and laboratory data of 35 patients with HCL treated in Hadassah between January 1999 and February 2010, in order to evaluate the frequency and characteristics of SR after treatment with cladribine. We found a high frequency of SR in our group of patients (18/35 patients, 51%), mostly related to febrile neutropenia and concomitant treatment with penicillins/trimethoprim-sulfamethoxazole (TMP-SMZ). The lymphocyte count was low in all patients with SR. We conclude that patients with HCL treated with cladribine have an increased rate of drug hypersensitivity, possibly due to T-cell imbalance induced by cladribine. Since TMP-SMZ and penicillins are related to SR in most cases and are important in the management of patients with HCL, a desensitization protocol should be considered. Rechallenge may be safe after immune reconstitution.

Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Agents; Cladribine; Exanthema; Female; Humans; Incidence; Leukemia, Hairy Cell; Male; Middle Aged; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Abscess; Anti-Infective Agents; Chills; Exanthema; Fever; Furunculosis; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pancytopenia; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Allopurinol; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Carbamazepine; Child; Drug Combinations; Drug Eruptions; Eosinophilia; Exanthema; Female; Glucosamine; Gout Suppressants; Humans; Male; Middle Aged; Pruritus; Retrospective Studies; Sulfasalazine; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Exanthema; Face; Facial Dermatoses; Female; Fever; Humans; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

In some patterns of cutaneous adverse drug reactions, and depending on the culprit drug, patch testing has been helpful in confirming its cause. Its value in Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) has not been established in a large cohort of patients.. The aim of the present study is to evaluate the safety and usefulness of patch testing in DRESS.. Between January 1998 and December 2008, we studied 56 patients with DRESS induced by antiepileptic agents in 33 patients (59%), allopurinol in 19 (34%) and sulfasalazine, cotrimoxazole, tenoxicam, and amoxicillin in 1 patient each (7%).. A positive patch test reaction was observed in 18 patients (32.1%), of which 17 were with antiepileptics and 1 with tenoxicam. In the antiepileptic group, carbamazepine alone was responsible for 13 of 17 positive reactions (76.5%). Patch tests with allopurinol and its metabolite were negative in all cases attributed to this drug.. In this study, patch testing was a safe and useful method in confirming the culprit drug in DRESS induced by antiepileptic drugs, whereas it had no value in DRESS induced by allopurinol. The pathogenesis of DRESS is not yet entirely clarified, but positive patch tests suggest a drug-dependent delayed hypersensitivity mechanism.

Topics: Allopurinol; Amoxicillin; Anticonvulsants; Drug Hypersensitivity; Eosinophilia; Exanthema; Female; Humans; Male; Middle Aged; Patch Tests; Sulfasalazine; Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

We report on a patient with Pneumocystis jirovecii pneumonia who developed fever, rash, eosinophilia and hepatitis 10 days after initiation of a therapy with sulfamethoxazole and trimethoprim. A DRESS syndrome was diagnosed and the therapy was changed successfully to pyrimethamine and dapsone. We describe the clinical picture, causative drugs, pathogenesis, differential diagnoses and therapy of this life-threatening disease to acquaint the general practitioner with it.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Diagnosis, Differential; Doxorubicin; Drug Eruptions; Drug Hypersensitivity; Eosinophilia; Exanthema; Fever of Unknown Origin; Humans; Liver Function Tests; Lymphoma, T-Cell; Male; Middle Aged; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Prednisone; Rituximab; Trimethoprim, Sulfamethoxazole Drug Combination; Vincristine

Topics: Acute Generalized Exanthematous Pustulosis; Adult; Anti-Infective Agents; Biopsy; Drug Eruptions; Exanthema; Female; Humans; Skin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Cephalosporins; Disease Progression; Emergencies; Exanthema; Humans; Male; Middle Aged; Penicillins; Sulfonamides; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Chemical and Drug Induced Liver Injury; Child, Preschool; Diagnosis, Differential; Drug Hypersensitivity; Exanthema; Humans; Male; Mucocutaneous Lymph Node Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (TMP-SMX) is a combination chemotherapeutic agent, a commonly used antibiotic. Adverse drug reactions occur in 6-8% of patients. Although, the most common adverse reactions include mild gastrointestinal distress and cutaneous events, also a wide range of hematological abnormalities have been ascribed to TMP-SMX. We report a 40-year-old male patient who developed an early onset neutropenia, thrombocytopenia, generalised rash and oral candidiasis after 5 days long TMP-SMX therapy. Although generalised rash may seen more and improves with discontinuation of the therapy; severe neutropenia, thrombocytopenia and oral candidiasis are seen very rare and rarely leads to fatality as it was in our case. Despite thrombocyte transfusions, whole blood transfusions, red cell concentrates and filgrastim therapy we lost our patient. We want to underline that although the TMP-SMX combination is usually well tolerated it can also lead to fatal complications.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Candidiasis, Oral; Cefepime; Cephalosporins; Chlorhexidine; Drug Eruptions; Escherichia coli; Escherichia coli Infections; Exanthema; Fatal Outcome; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Male; Meropenem; Neutropenia; Nystatin; Platelet Transfusion; Prednisolone; Recombinant Proteins; Thienamycins; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Emergency Service, Hospital; Erythromycin; Exanthema; Female; Fluid Therapy; Humans; Saudi Arabia; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Asthma; Biopsy; Diagnosis, Differential; Erythema Nodosum; Exanthema; Female; Humans; Irritable Bowel Syndrome; Leg; Lymphatic Diseases; Mycobacterium tuberculosis; Pain; Radiography; Sarcoidosis; Skin; Trimethoprim, Sulfamethoxazole Drug Combination; Tuberculin Test; Tuberculosis, Pulmonary

Topics: Biopsy; Drug Eruptions; Exanthema; Humans; Keratinocytes; Male; Middle Aged; Postoperative Complications; Prostatectomy; Skin; Skin Diseases, Vesiculobullous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

We studied an acute generalized exanthematous pustulosis (AGEP) due to sulfamethoxazol in a 48-year-old woman with unusual findings in allergy testing. The histological picture provided evidence for a pustular drug eruption and leukocytoclastic vasculitis. Skin testing with sulfamethoxazol was negative for immediate-type reaction (scratch test) and delayed-type reaction (epicutaneous testing). A lymphocyte transformation test (LTT) showed a significant lymphocyte stimulation (stimulation index 5.04/2.61) toward sulfamethoxazol (200/100 mg/ml) by measuring the rate of built-in tritium-thymidine in the DNS of the patients lymphocytes, implicating a drug-specific hypersensibility of lymphocytes; we could be dealing with a combined type III and IV reaction by Coombs and Gell in this case. LTT may play a possible role in the determination of drug allergy in AGEP despite negative skin testing.

Topics: Administration, Topical; Anti-Infective Agents; Anti-Inflammatory Agents; Betamethasone; Drug Eruptions; Exanthema; Female; Glucocorticoids; Humans; Lymphocyte Activation; Middle Aged; Skin Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Anti-Infective Agents, Urinary; Diagnosis, Differential; Drug Eruptions; Exanthema; Humans; Kidney Transplantation; Male; Middle Aged; Serum Sickness; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination; Urticaria

The aim of this study was to evaluate epidemiological, clinical and laboratory data of shigellosis in children from northern Greece, hospitalized in our department during the period 1971-96. In total, 422 cases of shigellosis, aged 1 month to 14 y (238M, 184F) were hospitalized during the study period. The annual distribution was approximately stable until 1990, the mean number of cases per year being about 20. During the last 4 y the incidence significantly decreased. Shigella was serotyped in 138/422 cases. Seventy six of the strains were S. flexneri (55%) and 56 S. sonnei (40%). In the majority of cases the clinical picture was mild. Severe dehydration was seen in only 6 patients. Ninety four patients (22%) had extra-intestinal manifestations. Most common of these were convulsions (16%) and, less frequently, disturbances of consciousness (n = 26), rash (n = 9), shock and disseminated intravascular coagulopathy (n = 2), nerve paralysis (n = 2), severe anaemia (n = 2) and haemolytic-uraemic syndrome (n = 1). Nine patients had acute encephalopathy of 12 h to 12 d duration. It is important to note that all these cases recovered completely with no residual neurological deficit, except for 1 girl who developed temporal epilepsy 8 y later. Spinal fluid was normal in all 42 examined patients. Antibiotics were given to 212 of 422 patients, mainly during the first half of the study period. Shigella resistance to antibiotic was significant for cotrimoxazole (24%) and ampicillin (16%). All patients were cured. Shigellosis is a mild disease in our area, with a decreasing prevalence.

Topics: Adolescent; Ampicillin; Anemia; Anti-Bacterial Agents; Child; Child, Preschool; Consciousness Disorders; Dehydration; Disseminated Intravascular Coagulation; Drug Resistance, Microbial; Dysentery, Bacillary; Exanthema; Female; Greece; Hemolytic-Uremic Syndrome; Humans; Incidence; Infant; Male; Paresis; Penicillins; Seizures; Shigella; Shock; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Animals; Anti-Infective Agents; Cell Line; Child, Preschool; Exanthema; Fever; Humans; Influenza A virus; Influenza, Human; Macaca mulatta; Male; Purpura; Trimethoprim, Sulfamethoxazole Drug Combination

Of 19,653 patients hospitalized in the medical divisions of two teaching hospitals, 3980 were treated with an aminopenicillin, 808 with other penicillins, 427 with a cephalosporin, 2619 with cotrimoxazole and 846 with allopurinol. The first part of the study deals only with the incidence of exanthemas definitely or probably due to a specific drug on the basis of clinical considerations. The exanthema incidence is 8.0% for aminopenicillins, 4.7% for other penicillins, 1.9% for cephalosporins and 2.8% for cotrimoxazole. The second part of the study employs a cross-tabulation to determine the incidence of exanthemas definitely and probably drug-induced, and the temporal relationship of these reactions to aminopenicillin and allopurinol exposure. The observed risks of developing an exanthema are as follows: aminopenicillin without allopurinol 10.1%, aminopenicillin combined with allopurinol 7.2%, allopurinol without aminopenicillin 3.0%, neither of the two drugs 1.5%. The increased incidence of exanthemas observed by the Boston Collaborative Drug Surveillance Program (BCDSP) in patients concomitantly treated with aminopenicillin and allopurinol was not confirmed by our results. Our hypothesis is that the time of exposure to aminopenicillins might have been shorter for patients of the BCDSP who were not treated in connection with neoplastic disease and did not receive allopurinol. The incidence of aminopenicillin induced exanthemas increases severalfold with the duration of exposure time during the first 2-3 weeks. In the CHDMB, on the other hand, exposure time does not differ between the patients treated with aminopenicillin alone or in combination with allopurinol.

Topics: Allopurinol; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Cephalosporins; Dose-Response Relationship, Drug; Drug Combinations; Drug Utilization; Exanthema; Humans; Medication Systems, Hospital; Penicillins; Pharmacy Service, Hospital; Sulfamethoxazole; Switzerland; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Utilization Review

Topics: Anti-Infective Agents, Urinary; Arteritis; Drug Combinations; Exanthema; Female; Humans; Liver Function Tests; Middle Aged; Nephritis, Interstitial; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination