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A new study underscores the risks associated with commonly prescribed oral antibiotics, revealing that some are linked to a higher incidence of severe drug rashes that can lead to life-threatening conditions. Conducted by researchers from ICES, Sunnybrook Research Institute, and the University of Toronto’s Temerty Faculty of Medicine, the study suggests that healthcare providers should consider opting for lower-risk antibiotics when clinically appropriate.
Published in the Journal of the American Medical Association (JAMA), the study titled “Oral Antibiotics and the Risk of Serious Cutaneous Adverse Drug Reactions” identifies two classes of antibiotics—sulfonamides and cephalosporins—as having the highest risk for severe cutaneous adverse drug reactions (cADRs). These reactions, which can involve both the skin and internal organs, are rare but can be potentially life-threatening, with mortality rates ranging from 20 to 40%.
The research analyzed healthcare data from ICES, focusing on adults aged 66 and older who were prescribed oral antibiotics between 2002 and 2022 in Ontario, Canada. Of the 21,758 adults who experienced a serious cADR and required emergency department (ED) visits or hospitalizations, 87,025 were matched as controls who did not suffer from such reactions.
Key findings from the study include:
- Highest Risk Antibiotics: Sulfonamides (“sulfa drugs”) and cephalosporins were found to carry the greatest risk of severe cADRs. All antibiotics were associated with a higher risk compared to macrolides, but these two classes stood out in terms of severity.
- Hospitalization and Mortality: Among those admitted to the hospital, 20% required treatment in intensive care units (ICUs), and 5% of these patients died, highlighting the critical nature of some reactions.
- Prevalence: There were two cADR-related hospital visits for every 1,000 antibiotic prescriptions. Approximately one in eight patients presenting to the ED with antibiotic-related cADRs were hospitalized.
The study’s lead author, Erika Lee, an allergist and trainee with ICES and Temerty Medicine’s Eliot Phillipson Clinician-Scientist Training Program, emphasized the importance of this research. “Clinicians have speculated that certain antibiotics carry greater risk for severe reactions, but this study provides concrete evidence of these risks, especially in older adults who receive a higher volume of antibiotic prescriptions.”
David Juurlink, a staff internist and head of the Division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Center, stressed the importance of vigilance. “Patients should be aware of symptoms such as rash and fever, which can develop weeks after starting antibiotics. This study also reinforces the need for careful prescribing practices and the importance of using antibiotics only when absolutely necessary.”
For more detailed information, refer to the full study in JAMA: DOI: 10.1001/jama.2024.11437.
Journal Information: Journal of the American Medical Association
