AZITHROMYCIN-INDUCED HYPERSENSITIVITY AND COVID-19: A CASE REPORT
DOI:
https://doi.org/10.22159/ijms.2024v12i4.50958Keywords:
Drug allergy, Macrolide, Severe acute respiratory syndrome-related coronavirus-2, Case reportAbstract
An adverse drug reaction is called drug hypersensitivity syndrome. However, experts regard macrolide allergies to be infrequent. Moreover, this group of antibiotics is considered relatively safe. Although azithromycin is prescribed in COVID-19 patients due to the positive observed effects, hypersensitivity syndrome from this agent has rarely been reported. The case study discusses a 30-year-old man, who was diagnosed with coronavirus disease 2019 and exhibited fever (39.1°C), diffuse maculopapular rash, shortness of breath, wheezing, swelling, itching, pain, subconjunctival hemorrhage, eosinophilia (8.9% of 10.2×103/μL leukocytes), and elevated aminotransferase level following treatment with azithromycin. The Naranjo algorithm classified this case in the “definite” category. Therefore, due to the high prevalence of COVID-19 and increased administration of azithromycin, physicians should be made aware of the potential for unusual toxicity associated with azithromycin, which may become more prevalent as its use continues to expand in the future.
References
Zeller A, Schaub N, Steffen I, Battegay E, Hirsch HH, Bircher AJ. Drug hypersensitivity syndrome to carbamazepine and human herpes virus 6 infection: Case report and literature review. Infection 2003;31:254-6.
Reiter J, Demirel N, Mendy A, Gasana J, Vieira ER, Colin AA, et al. Macrolides for the long-term management of asthma--a meta-analysis of randomized clinical trials. Allergy 2013;68:1040-9.
Peters DH, Friedel HA, McTavish D. Azithromycin. A review of its antimicrobial activity, pharmacokinetic properties and clinical efficacy. Drugs 1992;44:750-99.
Ivetić Tkalčević V, Cužić S, Kramarić MD, Parnham MJ, Haber VE. Topical azithromycin and clarithromycin inhibit acute and chronic skin inflammation in sensitized mice, with apparent selectivity for Th2- mediated processes in delayed-type hypersensitivity. Inflammation 2012;35:192-205.
Harris JA, Kolokathis A, Campbell M, Cassell GH, Hammerschlag MR. Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children. Pediatr Infect Dis J 1998;17:865-71.
Keating GM, Lyseng-Williamson KA, Garnock-Jones KP. Azithromycin 1.5% ophthalmic solution: A guide to its use in purulent bacterial conjunctivitis and trachomatous conjunctivitis. Drugs TherPerspect 2013;29:97-101.
Rubinstein E. Comparative safety of the different macrolides. Int J Antimicrob Agents 2001;18:71-6.
Sriratanaviriyakul N, Nguyen LP, Henderson MC, Albertson TE. Drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) syndrome associated with azithromycin presenting like septic shock: A case report. J Med Case Rep 2014;8:332.
WHO. Weekly Epidemiological Update on COVID-19; 2022. Available from: https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---22-february-2022 [Last accessed on 2022 Feb 26].
Amrutha VU, Arya GK, Arya M, Vijay V, Krishna A, Abhinandh B, et al. Supportive therapy: An option to enhance host immunity against COVID‐19. Int J Appl Pharm 2021;13:1-9.
Justyn M, Yulianti T, Wilar G. Long-term COVID-19 effect to endothelial damage trough extrinsic apoptosis led to cardiovascular disease progression: An update review. Int J Appl Pharm 2023;15:60-8.
Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020;56:105949.
Hashimoto Y, Suzuki T, Hashimoto K. Mechanisms of action of fluvoxamine for COVID-19: A historical review. Mol Psychiatry 2022;27:1898-907.
Lellou S, Sahnoun L, Youcef ND, Bouatam S, Bouhadda M. Hydroxychloroquine et azithromycine dans le traitement du COVID-19. À propos de 101 cas. Rev Maladies Respir Act 2021;13:108.
Nokra M, Batahar SA, Amro L. Effet bénéfique de l’association hydroxychloroquine ou chloroquine/azithromycine dans le traitement des patients atteints de COVID-19. Rev Maladies Respir Act 2021;13:110. 16. AraújoL,DemolyP.Macrolidesallergy.CurrPharmDes2008;14:2840-62.
Mori F, Pecorari L, Pantano S, Rossi ME, Pucci N, De Martino M, et al. Azithromycin anaphylaxis in children. Int J Immunopathol Pharmacol 2014;27:121-6.
Periti P, Mazzei T, Mini E, Novelli A. Adverse effects of macrolide antibacterials. Drug Saf 1993;9:346-64.
Zhanel GG, Dueck M, Hoban DJ, Vercaigne LM, Embil JM, Gin AS, et al. Review of macrolides and ketolides. Drugs 2001;61:443-98.
Greenhawt M, McMorris M, Baldwin J. Carmine hypersensitivity masquerading as azithromycin hypersensitivity. Allergy Asthma Proc 2009;30:95-101.
Barni S, Butti D, Mori F, Pucci N, Rossi ME, Cianferoni A, et al. Azithromycin is more allergenic than clarithromycin in children with suspected hypersensitivity reaction to macrolides. J Investig Allergol Clin Immunol 2015;25:128.
Adriaenssens N, Coenen S, Versporten A, Muller A, Vankerckhoven V, Goossens H, et al. European surveillance of antimicrobial consumption (ESAC): Quality appraisal of antibiotic use in Europe. J Antimicrob Chemother 2011;66:vi71-7.
Cascaval RI, Lancaster DJ. Hypersensitivity syndrome associated with azithromycin. Am J Med 2001;110:330-1.
Bauer KA, Brimhall AK, Chang TT. Drug reaction with eosinophilia and systemic symptoms (DRESS) associated with azithromycin in acute Epstein-Barr virus infection. Pediatr Dermatol 2011;28:741-3.
Flavia Monteagudo Paz A, Salvador JF, Martínez NL, Montero LC, Alberola FT. Allergic contact dermatitis caused by azithromycin in an eye drop. Contact Dermatitis 2011;64:300-1.
Mimesh S, Pratt M. Occupational airborne allergic contact dermatitis from azithromycin. Contact Dermatitis 2004;51:151.
Hopkins S. Clinical toleration and safety of azithromycin. Am J Med 1991;91:S40-5.
Cadisch R, Streit E, Hartmann K. Exacerbation of pseudoparalytic myasthenia gravis following azithromycin (Zithromax). Schweiz Med Wochenschr 1996;126:308-10.
Published
How to Cite
Issue
Section
Copyright (c) 2024 Sajjad Sadeghi
This work is licensed under a Creative Commons Attribution 4.0 International License.
