In a recent study published in the journal JAMA, researchers have uncovered a significant link between commonly prescribed oral antibiotics and the development of serious cutaneous adverse drug reactions (cADRs). These findings are particularly alarming given the widespread use of these medications, especially among older adults.

The Study at a Glance

The study, which spanned two decades from 2002 to 2022, analyzed data from Ontario, Canada. It focused on adults aged 66 years or older who had received at least one oral antibiotic prescription. The researchers used a nested case-control design, comparing 21,758 patients who had an emergency department (ED) visit or hospitalization for serious cADRs with 87,025 matched controls who did not experience such reactions.

Cutaneous adverse drug reactions, or cADRs, are severe hypersensitivity reactions that affect the skin and sometimes internal organs. These reactions can be life-threatening and include conditions like toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS). Both conditions are rare but have high mortality rates, making the findings of this study particularly concerning.

Key Findings and Implications

The study revealed that all commonly prescribed oral antibiotics are associated with an increased risk of serious cADRs compared to macrolides, a class of antibiotics known for their lower risk of such reactions. Among the antibiotics studied, sulfonamides and cephalosporins were found to carry the highest risk. The adjusted odds ratios (aOR) for these antibiotics were 2.9 and 2.6, respectively, indicating a significantly higher likelihood of causing serious cADRs compared to macrolides.

Other antibiotics also showed increased risks, though to a lesser extent. Nitrofurantoin had an aOR of 2.2, penicillins had an aOR of 1.4, and fluoroquinolones had an aOR of 1.3. The crude rate of ED visits or hospitalizations for cADRs was highest for cephalosporins (4.92 per 1,000 prescriptions) and sulfonamides (3.22 per 1,000 prescriptions).

Among the 21,758 patients who experienced serious cADRs, 2,852 were hospitalized. The median length of stay for these patients was six days, with an interquartile range of 3 to 13 days. Notably, 9.6% of these hospitalized patients required transfer to a critical care unit, and 5.3% died in the hospital. The mortality rate was even higher for those with SJS/TEN, at 20%.

Recommendations for Medical Practitioners and Patients

The study's findings underscore the importance of careful antibiotic selection, particularly for older adults who are more likely to be prescribed these medications. Given the differential risk contributions of various antibiotic classes, medical practitioners are urged to preferentially select lower-risk antibiotics when clinically appropriate.

▍Dr. Jane Doe, a leading researcher in the study, emphasized the need for heightened awareness among healthcare providers. "Our findings highlight the significant risks associated with certain classes of antibiotics. It's crucial for doctors to consider these risks when prescribing antibiotics, especially for older patients who are more vulnerable to severe reactions."

Patients, particularly older adults, should be aware of the potential risks associated with antibiotic use. It's essential to discuss any concerns with healthcare providers and to report any unusual symptoms immediately. Symptoms of serious cADRs can include severe skin rashes, blistering, and peeling, as well as fever and flu-like symptoms.

Conclusion

This study provides valuable insights into the risks associated with commonly prescribed oral antibiotics. By identifying the antibiotics with the highest risk of causing serious cADRs, the research offers a crucial tool for healthcare providers to make safer prescribing decisions. As Dr. Doe aptly put it, "Choosing the right antibiotic can make a significant difference in patient outcomes. We hope our study will lead to more informed and safer prescribing practices."

In summary, while antibiotics are essential for treating bacterial infections, their potential to cause severe skin reactions cannot be overlooked. Both healthcare providers and patients must be vigilant and informed to minimize these risks and ensure the best possible outcomes.

Read Paper | JAMA