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A young male patient used fixed dose combinations of different fluoroquinolones and nitroimidazoles several times in the last few years for self-treating repeated episodes of diarrhea and loose motion. Each time, he experienced fixed drug eruptions that increased in number and severity on subsequent occasions. Suspecting association between the dru...
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Background & Aims
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Methods
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Citations
... Fixed dose combinations (FDCs) can improve patient compliance and decrease pill burden, but irrational prescribing of FDCs is a major health concern [40]. A case study reported the use of different fixed-dose combinations of fluoroquinolone-nitroimidazole for selftreatment, which induced recurrent fixed-drug eruptions [41]. ...
Objective: The objective of the study is to assess the drug usage pattern, personal hygiene, and sanitation practices among day scholars and hosteller medical students. Methods: A questionnaire-based cross-sectional study was conducted at MGM Medical College and M.Y. Hospital, Indore. Undergraduate and postgraduate medical students who experienced episodes of diarrhea in the past 6 months were included in the study. Diarrhea occurring due to organic causes was excluded. Data were collected using a Google or physical form and were analyzed using descriptive statistics. Results: 254 students who suffered from diarrhea in the past 6 months participated in the study, out of which 56% were hostellers. Commonly used drugs were ofloxacin, metronidazole, etc. 50.2% of them took self-medication; the majority of them were hostellers. Students were found to eat outside at least once a week. Personal hygiene and sanitation were more compromised among hostellers than day scholars. Conclusion: Personal hygiene and sanitation practices should be improved among medical students, especially hostel students. These students, despite being from medical backgrounds, still take irrational medication. Therefore, there is a need for increased awareness regarding drug usage, and self-medication should be discouraged.
... [28] Cross-sensitivity has been found with FDE as in other types of drug reactions: other sulfonamides and dapsone, tetracycline- oxyphenbutazone, [21,28] ciprofloxacin and norfloxacin, [1] secnidazole-metronidazole, levocetirizine-cetirizine, and fluoroquinolones-nitroimidazoles have been previously reported. [29][30][31][32] Nonsteroidal anti-inflammatory drug-induced FDE is found to be selective, and it does not show a cross-reactivity between the drugs. [33] ...
Fixed drug eruption (FDE) is a common entity encountered in our day-to-day clinical practice. It is a T-cell-dependent pathway with induction of interferon-gamma-producing CD8+ T-cells in the dermis and epidermis. It is not just a drug that causes a fixed eruption but has also been described with food known as fixed food eruption and also with other agents. The article describes the common causes and pathomechanism of FDE.
... Cutaneous adverse drug reactions (ADR) are distinct, sharply defined lesions, oval to rounded, can be single or multiple, usually seen in the extremities, genitals, or perianal area, but any part of the body can be affected [1][2][3]. We observe skin lesions typically 1-10 hours after exposure; redness and swelling appear first and can be associated with blisters, which can persist for a few weeks. ...
... We observe skin lesions typically 1-10 hours after exposure; redness and swelling appear first and can be associated with blisters, which can persist for a few weeks. Later healing occurs with residual hyperpigmentation [2,3]. Cutaneous drug eruptions are the most common type of drug reaction. ...
... Though the FDC of ofloxacin and ornidazole is inappropriate, it is commonly available without prescription and used in developing countries [3,[6][7][8]. Chakrabarti A. studied the proportion of physicians using the FDC of antiprotozoal and antibacterial agents for diarrhoeal disease from India. He found that out of 2163 physicians' prescriptions, 59% were prescribing FDC of the fixed-dose combinations of ofloxacin and ornidazole [13]. ...
Cutaneous drug eruptions are commonly occurring adverse drug reactions. Food and Drug Association does not recommend a fixed dose combination of ofloxacin-ornidazole; still, it is commonly practised in developing countries. Many patients take this combination of drugs for episodes of gastro-enteritis, often as self-medication. We are reporting a 25 years old male patient presenting with repeated episodes of adverse drug reaction to a fixed dose combination of ofloxacin-ornidazole.
... FDE is a delayed-type hypersensitivity reaction mediated by CD8+ T cells [4]. It can be caused by many different drug classes, including non-steroidal anti-inflammatory drugs, acetaminophen, antibiotics, antimalarials, and barbiturates [1]. ...
Fixed drug eruption (FDE) is a common cutaneous drug eruption. We are the first to report a case of polysensitive FDE to both trimethoprim-sulfamethoxazole (TMP-SMX) and doxycycline. Diagnosis of FDE is largely clinical, and it is important to establish a good medication history to identify the causative agent. Treatment depends on avoidance of the implicated drug.
... Self-medication is a prevalent global practice, which is considered a pattern of irrational use of medications [1,2]. Self-medication is "the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for a chronic or recurrent disease or symptoms" [3]. It has been reported that irrational use of medication drugs and use of self-medications may lead to loss of resources, increase microbial resistance, the emergence of serious complications, increase suffering and drug dependence [4]. ...
... Commonly affected sites were extremities (27), lips (20), head and neck excluding the lips (7) and genitalia (5). Number of FDE lesions varied from 1 to >6, with Figures 3 and 4], while one patient had an overlap of plaques and bullous lesions, and one patient had ulcerated lesion on the lips. ...
... Similarly, there was cross-reaction between secnidazole-metronidazole and levocetirizine-cetirizine. Cross-reaction between fluoroquinolones, nitroimidazoles, fluoroquinolone-nitroimidazole combinations, and levocetirizine-cetirizine have been previously reported. [20][21][22][23] In 5 patients with FDE following an NSAID, there was a history of FDE with an analgesic/antipyretic though the exact drug was unknown. It could imply recurrence with same or a related drug. ...
Background
A fixed-drug eruption (FDE) is a unique cutaneous adverse drug effect in the form of recurrent lesions at the same site after re-exposure to the offending agent.
Aim
The aim of the study was to identify changes in trends in fixed drug eruptions with regard to causative drug or patient risk factors.
Methods
Cases of FDEs encountered between March 2014 to May 2017 during routine pharmacovigilance activities were analyzed.
Results
FDEs made up 8.4% of total adverse drug reactions and 11.1% of cutaneous reactions. Majority of the patients were adults between 18 and 45 years old. The average lag period between drug intake and appearance of FDE was 2.04 days. Commonly affected sites were extremities, lips, head and neck, and genitalia. Number of FDE lesions varied from 1 to > 6, with nearly half the patients (46%) presenting with a single lesion. Antimicrobials (80.6%) and nonsteroidal anti-inflammatory drugs (20.8%) were most frequent drugs implicated. Route of administration was oral for all causative drugs. History of an FDE was positive in 26 (50.2%) of the cases. Majority of the patients (21 out of 25 or 84%) whose lesions appeared within minutes to hours of suspected drug intake had a history of FDE. Furthermore, 66.7% of patients with multiple lesions had a history of FDE while only 34.8% of patients with a single lesion had such a history.
Conclusion
FDEs are common cutaneous reactions with antimicrobials and anti-inflammatory agents, with increased likelihood of extensive and multiple lesions in patients with a history of FDE.
... Self-medication is a prevalent global practice, which is considered a pattern of irrational use of medications [1,2]. Self-medication is "the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for a chronic or recurrent disease or symptoms" [3]. It has been reported that irrational use of medication drugs and use of self-medications may lead to loss of resources, increase microbial resistance, the emergence of serious complications, increase suffering and drug dependence [4]. ...
... FDE are a muco-cutaneous reaction to ingested drugs like cotrimoxazole, tetracycline, barbiturates, salicylates, ibuprofen, oxyphenbutazone, acyclovir, griesofulvin, tranexemic acid, and colchicine 3,4 . FDE associated with levofloxacin, ofloxacin and ornidazole have been reported [3][4][5][6][7][8][9][10] . Saha et al, in a hospital based observational study, found that the fixed dose combination of fluoroquinolones and nitroimidazole was the second most common cause of cutaneous adverse drug reaction was the FDE being the second most common manifestation 11 . ...
Antibiotic use is common in the treatment of acute gastroenteritis and acute exacerbations of ulcerative colitis. Often a fixed drug combination of fluoroquinolones and nitroimidazole is used in such situations. We report two cases of fixed drug eruption (FDE) in patients with ulcerative colitis who received ornidazole with levofloxacin and ofloxacin, respectively. Herein, the drug used was a fixed dose combination of levofloxacin 250 mg and ornidazole 500 mg in the first case, and ofloxacin 200 mg and ornidazole 500 mg in the second case. In both the instances, the drug was used in the empirical therapy of an exacerbation of underlying ulcerative colitis. The first case was of a 38-year-old male who developed initial symptoms within an hour of intake of drug with itching and hyperpigmentation. The other patient was an 18-year-old male who developed skin lesions after two days (four doses) of the drug. Both patients improved with cessation of the drug. FDE with these agents has been reported only infrequently. The causality estimated for these cases was definite and probable for the first and second case, respectively. © 2017, Indian Academy of Clinical Medicine. All rights reserved.
... A few cases of FDE have been reported with the related drugs-metronidazole, [7,8] tinidazole [9] or both, [10] and different fixed-dose combinations of fluoroquinolone-nitroimidazole. [11] Our case happens to be the first case of generalized FDE due to albendazole. ...
Adverse drug reactions are a common hazard of modern pharmacotherapy; fixed drug eruption (FDE) is a distinctive cutaneous/mucosal drug reaction that characteristically recurs in the same site with each exposure to the offending drug. Commonly, FDE presents as an isolated patch or plaque which heals with hyperpigmentation, however, occasionally multiple skin lesions may be present; when it is called generalized or multifocal FDE. Although many drugs are known to cause FDE; newer culprit drugs are still being reported. Here, we report the first case of albendazole-induced generalized multifocal FDE from India.
Objectives
Ciprofloxacin (CIPRO) is a fluroquinolone class antibiotic used commonly for the treatment of various acute and chronic bacterial infections. However, recently there is increase in the case reports of CIPRO-induced Cutaneous Adverse Drug Reactions (CADRs). We aim to systematically review all the descriptive studies of CIPRO induced CADRs.
Methods
Medline (via PubMed) was searched without any language or date restriction from inception to March 2019 using search terms of “Ciprofloxacin” and “Cutaneous reactions.” We included only the descriptive studies, which elucidate the CADRs experienced by the patients following the administration of CIPRO. Two reviewers involved in study selection, data extraction and quality assessment of the included studies. Discrepancies were resolved by consensus between the reviewers.
Results
Thirty-nine studies (out of 446) were found to be eligible for the final inclusion. The dose of CIPRO among the included studies was ranging from 500 to 1,000 mg/day and duration of treatment was between 7 and 10 days. The most common CADRs observed were toxic epidermal necrolysis, Stevens–Johnson syndrome, fixed drug eruptions, bullous fixed drug reaction, acute generalized pustulosis, erythema multiforme, drug rash with eosinophilia and systemic symptoms and erythema nodosum.
Conclusions
Management of the CIPRO-induced CADRs is recommended with the complete cessation of the CIPRO, followed by supportive management with oral or topical glucocorticoids, emollients, and topical moisturizers. CIPRO is likely to cause CADRs, physicians should be vigilant while prescribing it to the patients.
