Clinical features, diagnosis and management of cephalosporin‐induced acute generalized exanthematous pustulosis

alexandrossfakianakis shared this article with you from Inoreader Clinical features, diagnosis and management of cephalosporin‐induced acute generalized exanthematous pustulosis via Journal of Clinical Pharmacy and Therapeutics We collected original research, clinical trial reports, case reports and reviews of cephalosporin-induced acute generalized exanthematous pustulosis (AGEP) by searching Chinese and English databases to explore the clinical features, treatment strategies and prognosis of cephalosporin -induced AGEP. Abstract What is Known and Objective Acute generalized exanthematous pustulosis (AGEP) is a serious and rare adverse reaction of cephalosporins. We aimed to describe the clinical features of cephalosporin-induced AGEP and provide a reference for rational clinical use of cephalosporins. Methods We systematically searched Chinese and English databases for cephalosporin-induced TGEP-related case reports, retrospective studies, clinical studies, and review articles published before May 2022. Results and Discussion A total of 43 patients from 35 articles were eligible, of which 28 (65.1%) were female, with a median age of 69 years. A total of 11 cephalosporins were suspected, the most commonly involved were ceftriaxone (41.9%), cephalexin (16.3%), and cefepime (9.3%). AEGP erupted primarily within 14 days after administration, manifested as nonfollicular pustules on an erythematous base, distributed favourably to the extremities (44.2%), trunk (23.3%), face (23.3%), and could involve the oral mucosa (11.6%). During AGEP resolution, the affected area had desquamation (39.5%). The acute phase of the disease may be accompanied by fever (>38.0°C) and elevated neutrophil count (>7500/mm3). Histology of AGEP showed subcorneal pustules (56.3%), intraepidermal cavernous pustules (37.5%), with papillary dermal edema (37.5%), containing neutrophils and eosinophilic infiltration (71.9%). After drug discontinuation, the median time to resolution of AGEP symptoms was 10 days (rang e 2, 90). What is New and Conclusion Cephalosporin-induced AGEP is rare and should be properly diagnosed. This serious cutaneous adverse reaction is self-limiting and has a favourable prognosis, usually resolves with drug interruption, and may require additional interventions, such as topical steroids. View on Web

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