Antibiotic hypersensitivity and adverse reactions: management and implications in clinical practice

Jourdan, A.; Sangha, Brijit; Kim, Eric; Nawaz, Sohrab; Malik, Vikram; Vij, Radhika; Sekhsaria, Sudhir

doi:10.1186/s13223-020-0402-x

Cited by 28 publications

(22 citation statements)

References 18 publications

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“…Patients treated with antibiotics experience a variety of adverse events including gastrointestinal distress, rash, anaphylaxis, and Stevens-Johnson syndrome. 31,35 A 2020 study of antibiotic-related adverse reactions found that 11% of patients treated with antibiotics in an outpatient setting experienced adverse reactions. 35 The study was a retrospective chart review, therefore, the model assumes that all adverse reactions reported in the study were significant enough to require follow-up care, though this may be an overestimation that is accounted for in the sensitivity analysis.…”

Section: Adverse Eventsmentioning

confidence: 99%

Economic Evaluation of FebriDx®: A Novel Rapid, Point-of-Care Test for Differentiation of Viral versus Bacterial Acute Respiratory Infection in the United States

Dick

Schneider

2021

Journal of Health Economics and Outcomes Research

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Background: Acute respiratory infections (ARIs) are commonly treated with antibiotics in outpatient settings, but many infections are caused by viruses and antibiotic treatment is therefore inappropriate. FebriDx®, a rapid point-of-care test that can differentiate viral from bacterial infections, can inform antibiotic treatment decisions. Objectives:The primary aim of this study is to conduct a literature-based US economic evaluation of a novel rapid point-of-care test, FebriDx®, that simultaneously measures two key infection biomarkers, C-reactive protein (CRP) and Myxovirus resistance protein A (MxA), to accurately differentiate viral from bacterial infection.Methods: A budget impact model was developed based on a review of published literature on antibiotic prescribing for ARIs in the United States. The model considers the cost of antibiotic treatment, antibiotic resistant infections, antibiotic-related adverse events, and point-of-care testing. These costs were extrapolated to estimate savings on a national level. Results:The expected national cost to treat ARIs under standard of care was US$8.25 billion, whereas the expected national cost of FebriDx point-of-care-guided ARI treatment was US$5.74 billion. Therefore, the expected national savings associated with FebriDx® rapid point-of-care testing was US$2.51 billion annually.Conclusions: FebriDx, a point of care test that can reliably aid in the differentiation of viral and bacterial infections, can reduce antibiotic misuse and, therefore, antibiotic resistant infections. This results in significant cost savings, driven primarily by the reduction in antibiotic resistant infections.

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Section: Adverse Eventsmentioning

confidence: 99%

Economic Evaluation of FebriDx®: A Novel Rapid, Point-of-Care Test for Differentiation of Viral versus Bacterial Acute Respiratory Infection in the United States

Dick

Schneider

2021

Journal of Health Economics and Outcomes Research

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“…[31][32][33][34] Adverse Events Patients treated with antibiotics experience a variety of adverse events including gastrointestinal distress, rash, anaphylaxis, and Stevens-Johnson syndrome. 31,35 A 2020 study of antibiotic-related adverse reactions found that 11% of patients treated with antibiotics in an outpatient setting experienced adverse reactions. 35 The study was a retrospective chart review, therefore, the model assumes that all adverse reactions reported in the study were significant enough to require follow-up care, though this may be an overestimation that is accounted for in the sensitivity analysis.…”

Section: Antibiotic Typementioning

confidence: 99%

“…31,35 A 2020 study of antibiotic-related adverse reactions found that 11% of patients treated with antibiotics in an outpatient setting experienced adverse reactions. 35 The study was a retrospective chart review, therefore, the model assumes that all adverse reactions reported in the study were significant enough to require follow-up care, though this may be an overestimation that is accounted for in the sensitivity analysis. Patients experiencing more mild adverse events are more likely to seek follow-up care in an outpatient setting, while emergent reactions like anaphylaxis and Stevens-Johnson syndrome are treated in the ED.…”

Section: Antibiotic Typementioning

confidence: 99%

“…31 Accounting for the distribution of total adverse events (11%) across settings for follow-up care, we estimate that 8% of all patients treated with antibiotics required follow-up care in an outpatient clinic, and 3% received care in the ED. 35 A 2018 study by Geller et al estimated that 9% of adverse event-related ED visits require hospitalization. 32 The overall probability of an ED visit requiring hospitalization was, therefore, 0.07%.…”

Section: Antibiotic Typementioning

confidence: 99%

“…For example, penicillin and sulfonamide antibiotics accounted for a larger proportion of adverse reactions than other antibiotic types. 31,35 Antibiotic-specific adverse event rates were estimated from two national studies of adverse drug events in EDs and outpatient clinics (Table 2). 31,32…”

Section: Antibiotic Typementioning

confidence: 99%

See 2 more Smart Citations

Economic Evaluation of FebriDx®: A Novel Rapid, Point-of-Care Test for Differentiation of Viral versus Bacterial Acute Respiratory Infection in the United States

Dick

Schneider

2021

JHEOR

View full text Add to dashboard Cite

Background: Acute respiratory infections (ARIs) are commonly treated with antibiotics in outpatient settings, but many infections are caused by viruses and antibiotic treatment is therefore inappropriate. FebriDx®, a rapid point-of-care test that can differentiate viral from bacterial infections, can inform antibiotic treatment decisions. Objectives: The primary aim of this study is to conduct a literature-based US economic evaluation of a novel rapid point-of-care test, FebriDx®, that simultaneously measures two key infection biomarkers, C-reactive protein (CRP) and\ Myxovirus resistance protein A (MxA), to accurately differentiate viral from bacterial infection. Methods: A budget impact model was developed based on a review of published literature on antibiotic prescribing for ARIs in the United States. The model considers the cost of antibiotic treatment, antibiotic resistant infections, antibiotic-related adverse events, and point-of-care testing. These costs were extrapolated to estimate savings on a national level. Results: The expected national cost to treat ARIs under standard of care was US $8.25 billion, whereas the expected national cost of FebriDx point-of-care-guided ARI treatment was US $5.74 billion. Therefore, the expected national savings associated with FebriDx® rapid point-of-care testing was US $2.51 billion annually. Conclusions: FebriDx, a point of care test that can reliably aid in the differentiation of viral and bacterial infections, can reduce antibiotic misuse and, therefore, antibiotic resistant infections. This results in significant cost savings, driven primarily by the reduction in antibiotic resistant infections.

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Clinical Characteristics, Disease Course, and Outcomes of Patients With Acute Generalized Exanthematous Pustulosis in the US

et al. 2022

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IMPORTANCEAcute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse reaction associated with systemic complications. Currently available data are largely limited to small retrospective case series.OBJECTIVE To describe the clinical characteristics, disease course, and outcomes of a heterogeneous group of patients with AGEP across the US. DESIGN, SETTING, AND PARTICIPANTSA retrospective review of a case series of patients was conducted from January 1, 2000, through July 31, 2020. All 340 included cases throughout 10 academic health systems in the US were scored retrospectively using the EuroSCAR scoring system, and patients with a score corresponding to probable or definite AGEP and aged 18 years or older were included. MAIN OUTCOMES AND MEASURESPatient demographic characteristics, clinical course, suspected causative agent, treatment, and short-and long-term outcomes.RESULTS Most of the 340 included patients were women (214 [62.9%]), White (206 [60.6%]), and non-Hispanic (239 [70.3%]); mean (SD) age was 57.8 (17.4) years. A total of 154 of 310 patients (49.7%) had a temperature greater than or equal to 38.0 °C that lasted for a median of 2 (IQR, 1-4) days. Of 309 patients, 263 (85.1%) developed absolute neutrophilia and 161 patients (52.1%) developed either absolute or relative eosinophilia. Suspected causes of AGEP were medications (291 [85.6%]), intravenous contrast agents (7 [2.1%]), infection (3 [0.9%]), or unknown (39 [11.5%]). In 151 cases in which a single medication was identified, 63 (41.7%) were β-lactam antimicrobials, 51 (33.8%) were non-β-lactam antimicrobials, 9 (6.0%) were anticonvulsants, and 5 (3.3%) were calcium channel blockers. The median time from medication initiation to AGEP start date was 3 (IQR, 1-9) days. Twenty-five of 298 patients (8.4%) had an acute elevation of aspartate aminotransferase and alanine aminotransferase levels, with a peak at 6 (IQR, 3-9) days. Twenty-five of 319 patients (7.8%) experienced acute kidney insufficiency, with the median time to peak creatinine level being 4 (IQR, 2-5) days after the AGEP start date. Treatments included topical corticosteroids (277 [81.5%], either alone or in combination), systemic corticosteroids (109 [32.1%]), cyclosporine (10 [2.9%]), or supportive care only (36 [10.6%]). All-cause mortality within 30 days was 3.5% (n = 12), none of which was suspected to be due to AGEP.CONCLUSIONS AND RELEVANCE This retrospective case series evaluation of 340 patients, the largest known study cohort to date, suggests that AGEP onset is acute, is usually triggered by recent exposure to an antimicrobial, may be associated with liver or kidney complications in a minority of patients, and that discontinuation of the triggering treatment may lead to improvement or resolution.

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Antibiotic hypersensitivity and adverse reactions: management and implications in clinical practice

Cited by 28 publications

References 18 publications

Economic Evaluation of FebriDx®: A Novel Rapid, Point-of-Care Test for Differentiation of Viral versus Bacterial Acute Respiratory Infection in the United States

Economic Evaluation of FebriDx®: A Novel Rapid, Point-of-Care Test for Differentiation of Viral versus Bacterial Acute Respiratory Infection in the United States

Economic Evaluation of FebriDx®: A Novel Rapid, Point-of-Care Test for Differentiation of Viral versus Bacterial Acute Respiratory Infection in the United States

Clinical Characteristics, Disease Course, and Outcomes of Patients With Acute Generalized Exanthematous Pustulosis in the US

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