Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy

Abstract

Antibiotics are used extensively in the treatment of various infections. Consequently, they can be considered among the most important agents involved in adverse reactions to drugs, including both allergic and non-allergic drug hypersensitivity [J Allergy Clin Immunol 113:832-836, 2004]. Most studies published to date deal mainly with reactions to the beta-lactam group, and information on hypersensitivity to each of the other antimicrobial agents is scarce. The present document has been produced by the Special Committee on Drug Allergy of the World Allergy Organization to present the most relevant information on the incidence, clinical manifestations, diagnosis, possible mechanisms, and management of hypersensitivity reactions to non beta-lactam antimicrobials for use by practitioners worldwide.

Figure 1

Effect of cotrimoxazole (Sulfamethoxazole and Trimethoprim) on folate synthesis.

Figure 2

Sulfonamide chemical structure and metabolism. a: Sulfonamide core structure. It is present as sulfonyl-arylamine, where a sufonamide is attached to a benzene ring with an unsubstituted amine (-NH2) moiety at the N4 position. Many other drugs may also contain a sulfonamide (example: furosemide). b: SMX is metabolized intra-hepatically to SMX-NHOH, which is further oxidised to SMX-NO; the later binds covalently to cystein in proteins.