Severe cutaneous adverse reactions due to inappropriate medication use

Summary

Backgroud

The proportion of severe cutaneous adverse reactions (SCARs) that could be avoided if medication use was consistent with good medical practice is unknown.

Objectives

To estimate the proportion of SCARs related to inappropriate medication use.

Methods

Retrospective study of all validated SCARs collected in a French registry between 2003 and 2016. For each case, all plausible drugs suspected to induce SCARs (i.e., not just the drug regarded as "the most probable") were considered regarding three causes of preventability: (1) prescription for an inappropriate indication, (2) unintentional rechallenge despite a previous allergy to the drug, or (3) self-medication with prescription medicines.

Results

602 cases were included in the analyses. Antibiotics, anticonvulsants and allopurinol were the drugs most frequently involved, accounting for more than 50% of all cases. All suspected medications were considered appropriately used for 417 of the 602 individuals included in the study population (69.3%, 95% CI [65.6-73.0]),and inappropriately used. for 144 individuals (23.9% [20.5-27.3]).. These inappropriate uses were mainly due to prescriptions for inappropriate indication (65.8% [58.4-73.2]) or unintentional rechallenge (20.9% [14.6-27.2]). Allopurinol and cotrimoxazole were the drugs most frequently involved in inappropriate indications (accounting for 51.9% [42.3-61.5] and 13.5% [6.9-20.1] of cases, respectively). Antibiotics were the largest group involved in unintentional rechallenge. Non-steroidal anti-inflammatory drugs available on prescription were most involved in inappropriate self-medication.

Conclusions

Our results underline the need for respecting the appropriate indication of drugs to reduce the incidence of SCARs. All efforts to reduce unintentional rechallenge also seem to be necessary preventive measures.

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