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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Cross-reactivity among and between macrolides, lincosamides, and streptogramins: Study on the French
Quentin Le Baron1, Delphine Bourneau-Martin1, Marina Babin1
1Department of Pharmacology-Toxicology and Pharmacovigilance, University Hospital of Angers, Angers, France.
Background:
Hypersensitivity reactions (HSR) are reported for the macrolides, lincosamides, and streptogramins (MLS) antibiotic family. Data about cross-reactivity among and between MLS remain scarce or controversial.
Objectives:
The aim of this study was to provide an overview of hypersensitivity cross-reactions among MLSs based on data extracted from the French National Pharmacovigilance Database (FPVD).
Methods:
Cases of HSR to MLSs reported between January 1985 and December 2019 were extracted from the FPVD using standardized MedDRA queries (SMQ). Cases including an allergological test involving multiple MLSs and giving at least one positive result were included.
Results:
Of the 8394 cases reviewed, 149 were included. HSR mainly involved pristinamycin (n = 83; 53.2%) and spiramycin (n = 31; 19.9%). HSR to MLS was immediate in 54 cases and delayed in 94 cases. Skin tests represented the majority of the allergological tests performed (n = 728; 84.7%), followed by reintroduction tests (n = 79; 9.2%). Eighty-six cross-reactivities among MLS were identified in 62 cases (41.6%). All the 25 explorations performed for streptogramins showed cross-reactivities, but only 30/253 among macrolides (11.9%). Cross-reactivities between the three MLS were observed in 31/322 (9.6%) of the allergological explorations.
Conclusion:
This study highlights the possibility of cross-reactivity among and between MLSs. Dermatologists and allergologists managing patients with HSR to MLSs should be aware of a risk of cross-reactivity among the macrolides and between the different classes of MLS and to perform MLSs allergological testing before recommending an alternative antibiotic, especially in severe drug hypersensitivity from the MLS family.
Insights
Hypersensitivity reactions (HSR) to macrolides, lincosamides, and streptogramins (MLS) antibiotics can cross-react. Allergological testing is crucial for patients with MLS HSR to guide alternative antibiotic selection and manage potential cross-reactivity risks.
Area of Science:
- Pharmacovigilance
- Clinical Immunology
- Infectious Diseases
Background:
- Hypersensitivity reactions (HSR) are known for macrolides, lincosamides, and streptogramins (MLS) antibiotics.
- Existing data on cross-reactivity among and between MLS antibiotics are limited and often contradictory.
Purpose of the Study:
- To investigate hypersensitivity cross-reactions within and between MLS antibiotic classes.
- To analyze data from the French National Pharmacovigilance Database (FPVD) for HSR to MLS antibiotics.
Main Methods:
- Retrospective analysis of HSR cases reported to MLS antibiotics in the FPVD (1985-2019).
- Inclusion of cases with allergological testing showing positive results for multiple MLS antibiotics.
- Utilized standardized MedDRA queries (SMQ) for data extraction.
Main Results:
- 149 out of 8394 reviewed cases met inclusion criteria.
- Pristinamycin and spiramycin were the most frequently implicated MLS antibiotics.
- 86 cross-reactivities among MLS were identified in 62 cases (41.6%), with higher rates for streptogramins and between MLS classes.
Conclusions:
- Cross-reactivity is a significant possibility among and between MLS antibiotics.
- Clinicians, particularly dermatologists and allergologists, must consider MLS cross-reactivity in patients with HSR.
- Allergological testing for MLS is recommended before prescribing alternative antibiotics, especially in severe cases.
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