Drug eruptions in children with ENT infections

A common problem for the clinician in an outpatient clinic is to distinguish a drug eruption from a viral exanthem in a child. The aim of this study was to describe the common drug eruptions seen in children with ENT infections, suggesting an approach to this problem.

We studied the cases of ENT patients aged 15-years-old and below, with the clinical diagnosis of cutaneous adverse reactions. Main variables in the assessment of drug etiology in skin eruptions were previous experience with the drug in the general population, alternative explanation for the eruption, timing between the ingestion of the drug and the appearance of the lesions, drug levels or evidence of overdose or long-acting drug, subsequent progression of the eruption and reactions to dechallenge and rechallenge.

A total of 47 children were examined during a period of 11 months. The indications for drug prescribed were tonsillitis, pharyngitis, rhinitis, otitis and sinusitis. The most usually implicated drugs were amoxycillin-clavulanic acid, cephalosporin, clindamycin, erythromycin, clarithromycin and paracetamol. The main clinical patterns of the eruptions seen were urticaria, maculopapular rash, fixed drug eruption and erythema multiforme.

Careful clinical examination, detailed history, knowledge of the numerous clinical patterns of the eruptions and the drugs specific reaction rates, as well as oral drug rechallenge, RAST and patch tests if indicated, are essential factors in the management of patients with drug eruptions.