Photo Credit: Phuttaphat Tipsana

Sulfonamide antibiotics and cephalosporins are most strongly associated with serious cutaneous adverse drug reactions (cADRs), according to a study published in JAMA. Authors explored the risk for serious cADRs associated with commonly prescribed oral antibiotics and characterized outcomes of patients hospitalized for them in a nested case-control study using data for adults aged 66 years or older who received at least one oral antibiotic between 2002 and 2022. Cases were those with an emergency department visit or hospitalization for serious cADRs within 60 days of the prescription (21,758 older adults); each case was matched to four controls without emergency department visit or hospitalization for cADRs (87,025 matched controls). The researchers found that sulfonamide antibiotics and cephalosporins were most strongly associated with serious cADRs relative to macrolides in the primary analysis (adjusted odds ratios, 2.9 and 2.6, respectively). In addition, associations were seen for nitrofurantoin, penicillins, and fluoroquinolones (adjusted odds ratios, 2.2, 1.4, and 1.3, respectively). The highest crude rate of emergency department visits or hospitalization for cADRs was seen for cephalosporins and sulfonamide antibiotics (4.92 and 3.22 per 1,000 prescriptions, respectively). The median length of stay was six days among the 2,852 case patients hospitalized for cADRs; 9.6% and 5.3% required transfer to a critical care unit and died in the hospital, respectively.