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Original Article
Correlation between drugedrug interactioninduced StevenseJohnson syndrome and related deaths in Taiwan Q6
a,*
b
c
a
Fu-Jen Cheng , Fei-Kai Syu , Kuo-Hsin Lee , Fu-Cheng Chen , Chien-Hung Wu a, Chien-Chih Chen a a Department of Emergency
Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung County, Taiwan b College of Pharmacy, China Medical University, Taichung, Taiwan c Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
article info
abstract
Article history: Received 12 August 2015 Received in revised form
Concomitant use of some drugs can lead to interactions between them resulting in severe
19 October 2015
tionship between drug combinations and SJS-related mortality, with the hope that a
adverse effects. To date, there are few reports of incidences of Stevens-Johnson syndrome (SJS) associated with combination drug administration. Therefore, we studied the rela-
Accepted 19 November 2015
retrospective study of this nature would provide information crucial for the prevention of
Available online xxx
future drug-drug interaction related deaths attributable to SJS. This retrospective longitudinal study used mortality cases from 1999 to 2008 that were diagnosed as erythema
Keywords: adverse drug reaction allergy drug interaction Stevens-Johnson syndrome toxic epidermal necrolysis
multiforme (International Classification of Diseases, Ninth Revision, Clinical Modification 695.1) from the National Health Insurance database in Taiwan. Statistical comparisons of the results were performed using analysis of variance (ANOVA), independent sample ttests, and odds ratio (OR). In this way, the relationship between combinations of SJSinducing drugs and mortality could be determined. A total of 111 patients who had died, including 63 males and 48 females (66.0 ± 20 and 70.0 ± 17.7 years, respectively), were suspected of having experienced drug-drug interaction-related adverse effects. The associated drug combinations included allopurinol and ampicillin (p ¼ 0.049), carbamazepine and sulfamethoxazole/trimethoprim (TMP) (p < 0.0001), carbamazepine and phenytoin (p < 0.0001), sulfamethoxazole/TMP and phenytoin (p ¼ 0.015), sulfadoxine and piroxicam (p ¼ 0.045), phenobarbital and cephalexin (p < 0.0001), ampicillin and erythromycin (p < 0.0001),
erythromycin and minocycline (p < 0.0001),
and vancomycin and
ethambutol (p < 0.0001) administered 1 month before the patients' deaths. Caution should be exercised when administering any drugs that may possibly induce SJS. In addition, attention should be
paid to
ensure prompt identification of
interactions, and patients should should
be
immediately
be
closely monitored.
possible drug-drug
Furthermore,
medications
dis- continued at the first sign or symptom suggesting the
occurrence of drug-related SJS, and then prompt, adequate supportive care should be provided.
* Corresponding author. Number 123, Dapi Road, Niaosong Township, Kaohsiung County 833, Taiwan. E-mail address:
[email protected] (F.-J. Cheng). http://dx.doi.org/10.1016/j.jfda.2015.11.009 1021-9498/Copyright © 2016, Food and Drug Administration, Taiwan. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article in press as: Cheng F-J, et al., Correlation between drugedrug interaction-induced StevenseJohnson syndrome and related deaths in Taiwan, Journal of Food and Drug Analysis (2016), http://dx.doi.org/10.1016/j.jfda.2015.11.009
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