Amoxicillin-associated Stevens-Johnson syndrome or toxic epidermal necrolysis: systematic review

Abstract

Our aim was to explore and summarize available cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) suspected to be associated with amoxicillin reported in the literature. Electronic searches were conducted in several databases. Fifty-one publications describing a total of 64 patients who satisfied inclusion criteria were included in the review. The age of the patients ranged from 1.5-80 years (median: 24.5 years). TEN, SJS and SJS/TEN overlap were diagnosed in 30 (46.9%), 28 (43.8%) and 1 (1.6%) patients, respectively. SJS/TEN may occur promptly after administration of amoxicillin, but it could also be a delayed adverse effect. The total length of hospital stay ranged from 3-70 days (median: 16 days). Amoxicillin-induced SJS/TEN is accompanied by frequent occurrence of serious complications, long-term ocular and skin sequelae and high mortality rate. Clinicians should be aware that amoxicillin alone or combined with clavulanic acid can cause SJS/TEN in patients of all ages.

Keywords:

• Amoxicillin
• amoxicillin/clavulanic acid
• Stevens-Johnson syndrome
• toxic epidermal necrolysis
• adverse effect
• systematic review

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study was partially funded by grant No 175007 given by Ministry of Education, Science and Technological Development of the Republic of Serbia.