Comparative Evaluation of Antimicrobial and Anticonvulsant Induced Cases of Steven Johnson Syndrome and Toxic Epidermal Necrolysis

Background: Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) constitute a spectrum of severe, potentially life threatening, mucocutaneous adverse drug reactions. Antimicrobial agents and anticonvulsants are the most commonly implicated drugs. This study was aimed to compare and analyse the differences in the incubation peri-od, clinical presentation and outcome in patients of SJS/TEN caused by the antimicrobials and anticonvulsants. Materials and Methods: Patients of SJS, TEN and SJS/TEN overlap admitted in the dermatology ward of our hospi-tal, in whom an antimicrobial agent or an anticonvulsant were found to be probable causative agent by Naranjo score were assigned to Group A and B respectively. Inpatient records of the selected patients were studied to compare the differences. Results: Total of forty patients (twenty each of Group A and B) were included in the study. Fluoroquinolones followed by chloroquine were the most commonly implicated antimicrobials. The anticonvulsants most commonly implicated were phenytoin followed by carbamazepine. Incubation period in the antimicrobial group was significantly shorter [Group A (7.32 ± 5.4 days) vs Group B (28.58 ± 19.35 days)] with p value < 0.001. The duration of stay, in the derma-tology ward, was significantly longer (p value< 0.05) in the cases of TEN caused by antimicrobials (20.1 ± 7.49 days) as compared to those caused by anticonvulsants (14.5 ± 5.36 days). Three patients in Group A and one patient in Group B expired. Conclusion: A shorter incubation period and a higher morbidity and mortality were seen in the antimicrobial induced cases as compared to the anticonvulsant group.