Journal of Pharmacovigilance

Management of cross-reactivity among sulfonamides: A case report

6^th Pharmacovigilance Congress

September 28-30, 2016 Toronto, Canada

A Sainfort, F Raymond, M Bourdelin, O Ladjal, N Yahiaoui and H Bontemps

Hospital Nord-Ouest, France
Regional Pharmacovigilance Centre, France

Posters & Accepted Abstracts: J Pharmacovigil

Abstract:

A patient developed agranulocytosis after introduction of sulfonylurea agent. According to the Regional Pharmacovigilance Center (CRPV) it was a true hypersensitivity reaction. A month later, the patient is hospitalized for a bronchial infection where multidrugresistant bacterium is highlighted. The antibiogram shows the interest of sulfamethoxazole and the physician asked pharmacists for the management strategy. Sulfonamides are classified into 3 distinct groups based on their chemical structure: the sulfonylarylamines (including sulfonamide antibiotics), non sulfonylarylamines (including the sulfonylureas) and the sulfonamide derivatives. Analysis of the literature indicated that cross-reaction among different classes of sulfonamide drugs is unlikely to occur, especially between antibacterial sulfonamide and non-sulfa antibiotics because of their difference in structure. An immunoallergic response usually occurs within the first 48 hours in the re-entry of the causal treatment or in case of cross-reaction with a drug of similar chemical structure. In the absence of potential therapeutic alternative, the sulfamethoxazole was introduced with a close biological monitoring. The clinical and biological evolution has been favorable. Among the antibiotics, sulfa allergy is the most common allergy after the beta-lactams. 3% of patients treated with sulfonamides antibiotics develop a severe allergy. In contrast the risk is very rare with nonantibiotic sulfonamides. This case illustrates the collaboration between physicians, pharmacists and the CRPV in the management of complex therapeutic issues. The risk of cross-reactivity between different sulfonamides exists but it is very rare and reintroduction is discussed depending on the severity of the adverse event occurred previously and the risks and benefits of the therapy.

Biography :

Email: anne.sainfort@yahoo.fr