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DRESS syndrome, rebound effect and medication error: 11 case reports In a prospective study conducted between 01 April 2012 and 31 March 2015, 11 children (7 girls and 4 boys) aged 2–12 years were described, who developed DRESS syndrome during treatment with lamotrigine, cefotaxime, carbamazepine, phenytoin, phenobarbital, amoxicillin/clavulanic acid, amoxicillin, ampicillin or unspecified penicillins for seizures, cerebral palsy or respiratory tract infection. In 4 of the 11 children, DRESS syndrome was attributed to pharmacokinetic interaction of lamotrigine and sodium valproate (n=1) or pharmacokinetic interaction of lamotrigine with phenobarbital or phenytoin following a drug titration error (n=3). One of these children additionally exhibited rebound effect during treatment with prednisolone for DRESS syndrome [duration of treatments to reaction onsets not stated; not all routes and dosages stated]. The children, who had seizure disorder (7 children) and respiratory tract infection (4 children), had been receiving lamotrigine (4 children), cefotaxime (1 child), carbamazepine (2 children), phenytoin and phenobarbital (1 child), amoxicillin/clavulanic acid (1 child), amoxicillin/clavulanic acid and unspecified penicillins [crystalline penicillin] (1 child), and amoxicillin/clavulanic acid, amoxicillin and ampicillin (1 child). Lamotrigine was administered at an initial dose of 2–25mg daily or on alternate days in 4 patients. Subsequently, they developed DRESS syndrome and were admitted. Four of the 7 children with seizure disorder (patient 1, 2, 4 and 5), were also receiving sodium valproate (2 children), sodium valproate and phenytoin (1 child) and phenobarbitone (1 child) concomitantly that led to altered levels of lamotrigine (pharmacokinetic interaction), which contributed to DRESS syndrome. In 3 children (patient 2, 4 and 5) lamotrigine was not administered according to the guidelines for slow titration to the therapeutic dose (recommended initial dose: 0.15–0.6 mg/kg/day in week 1 and 2, and 0.3–1.2 mg/kg/day in week 3 and 4). In the remaining children, DRESS was attributed to carbamazepine (patient 6 and 8), phenytoin and phenobarbital (patient 7), amoxicillin/clavulanic acid (patient 9 and 10) and amoxicillin/clavulanic acid with ampicillin and amoxicillin (patient 11). The children were treated with tapering doses of oral prednisolone that resulted in improvement except in one child (patient 1), who experienced disease flares upon tapering the dose of oral prednisolone 0.5–1 mg/kg/day (rebound effect), and thus required 84 days of treatment for improvement. Laboratory tests showed eosinophilia, atypical lymphocytes or enlargement of lymph nodes. The RegiSCAR score for DRESS ranged between 4 and 8. Sasidharanpillai S, et al. Drug reaction with eosinophilia and systemic symptoms in children: A prospective study. Pediatric Dermatology 33: e162-e165, No. 2, Mar-Apr 803505702 2016. Available from: URL: http://doi.org/10.1111/pde.12803

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