Antibiotics and Stevens-Johnson syndrome

Warning features include a painful or spreading rash, blisters, peeling skin, sores in the mouth or around the eyes, fever, and feeling markedly unwell. Do not take another dose of a suspected medicine while seeking emergency medical advice, unless an emergency clinician specifically directs otherwise.

Stevens-Johnson syndrome is an immune reaction that injures the skin and moist linings of the body. It may begin with fever, sore throat, eye discomfort, or fatigue before painful skin changes develop. The mouth, lips, eyes, and genital area can become inflamed or blistered.

A limited, non-painful rash can occur for other reasons during antibiotic treatment, including the infection itself. Even so, a new rash needs prompt clinical review because appearance alone may not reliably identify the cause or predict whether it will worsen.

If there is blistering, skin pain, peeling, facial swelling, or involvement of the eyes or mouth, go to an emergency department now. Take the antibiotic package and a list of all medicines, including medicines started recently and non-prescription products. Note when each was begun and when symptoms appeared.

Do not try a leftover antibiotic or restart the suspected drug later. Once clinicians assess the reaction, ask them to record the medicine and reaction clearly in your medical record. Tell future prescribers and pharmacists about it before receiving any medicine.

Call emergency services for trouble breathing, faintness, confusion, rapidly worsening swelling, or extensive skin peeling. Emergency assessment is also needed for a painful rash with fever, blisters, mouth ulcers, gritty or painful eyes, difficulty swallowing, or pain when passing urine.

For a new rash without these features, contact the prescribing clinician promptly before the next planned dose. A clinician can assess the skin, review every recent medicine, and decide how the infection should be treated safely.

Ask which medicine is suspected, whether related medicines should also be avoided, how the reaction will be documented, and what alternative can treat the original infection. Also ask what eye, mouth, skin, or genital symptoms need follow-up after discharge.