■严重的皮肤药物不良反应(cADR)是涉及皮肤和内脏器官的潜在危及生命的药物超敏反应。抗生素是这些反应的公认原因,但没有研究比较不同抗生素类别的相对风险。
■为了探讨与常用口服抗生素相关的严重cADR的风险,并描述住院患者的预后。
■使用基于人群的关联管理数据集的巢式病例对照研究,在安大略省66岁或以上的成年人中,在2002年至2022年间至少接受了一种口服抗生素,加拿大。病例是在处方后60天内因严重cADR而接受急诊科(ED)就诊或住院的患者,每个病例与多达4个未匹配的对照。
■各种口服抗生素。
■不同类别的口服抗生素与严重cADR之间的关联的条件逻辑回归估计,使用大环内酯类作为参照组。
■在20年的研究期间,我们确定了21758名老年人(平均年龄,75岁;64.1%的女性)在抗生素治疗后因严重cADR而进行ED访问或住院,而87025名匹配的对照组则没有。在初步分析中,磺胺类抗生素(调整后的比值比[aOR],2.9;95%CI,2.7-3.1)和头孢菌素(aOR,2.6;95%CI,2.5-2.8)与大环内酯类药物的严重cADR密切相关。与呋喃妥因(aOR,2.2;95%CI,2.1-2.4),青霉素(aOR,1.4;95%CI,1.3-1.5),和氟喹诺酮(aOR,1.3;95%CI,1.2-1.4)。cADR的ED访视或住院率最高的是头孢菌素(每1000个处方4.92个;95%CI,4.86-4.99)和磺胺类抗生素(每1000个处方3.22个;95%CI,3.15-3.28)。在因cADR住院的2852例患者中,中位住院时间为6天(IQR,3-13天),9.6%需要转移到重症监护病房,5.3%在医院死亡。
■与大环内酯类药物相比,常用的口服抗生素与严重cADR的风险增加有关,磺胺类和头孢菌素携带的风险最高。在临床上适当时,处方者应优先使用风险较低的抗生素。
UNASSIGNED: Serious cutaneous adverse drug reactions (cADRs) are potentially life-threatening drug hypersensitivity reactions involving the skin and internal organs. Antibiotics are a recognized cause of these reactions, but no studies have compared relative risks across antibiotic classes.
UNASSIGNED: To explore the risk of serious cADRs associated with commonly prescribed oral antibiotics, and to characterize outcomes of patients hospitalized for them.
UNASSIGNED: Nested case-control study using population-based linked administrative datasets among adults aged 66 years or older who received at least 1 oral antibiotic between 2002 and 2022 in Ontario, Canada. Cases were those who had an emergency department (ED) visit or hospitalization for serious cADRs within 60 days of the prescription, and each case was matched with up to 4 controls who did not.
UNASSIGNED: Various classes of oral antibiotics.
UNASSIGNED: Conditional logistic regression estimate of the association between different classes of oral antibiotics and serious cADRs, using macrolides as the reference group.
UNASSIGNED: During the 20-year study period, we identified 21 758 older adults (median age, 75 years; 64.1% female) who had an ED visit or hospitalization for serious cADRs following antibiotic therapy and 87 025 matched controls who did not. In the primary analysis, sulfonamide antibiotics (adjusted odds ratio [aOR], 2.9; 95% CI, 2.7-3.1) and cephalosporins (aOR, 2.6; 95% CI, 2.5-2.8) were most strongly associated with serious cADRs relative to macrolides. Additional associations were evident with
nitrofurantoin (aOR, 2.2; 95% CI, 2.1-2.4), penicillins (aOR, 1.4; 95% CI, 1.3-1.5), and fluoroquinolones (aOR, 1.3; 95% CI, 1.2-1.4). The crude rate of ED visits or hospitalization for cADRs was highest for cephalosporins (4.92 per 1000 prescriptions; 95% CI, 4.86-4.99) and sulfonamide antibiotics (3.22 per 1000 prescriptions; 95% CI, 3.15-3.28). Among the 2852 case patients hospitalized for cADRs, the median length of stay was 6 days (IQR, 3-13 days), 9.6% required transfer to a critical care unit, and 5.3% died in the hospital.
UNASSIGNED: Commonly prescribed oral antibiotics are associated with an increased risk of serious cADRs compared with macrolides, with sulfonamides and cephalosporins carrying the highest risk. Prescribers should preferentially use lower-risk antibiotics when clinically appropriate.