From the Guidelines
DRESS syndrome and Stevens-Johnson syndrome require distinct antibiotic approaches. In DRESS syndrome, antibiotics are typically not the primary treatment, whereas in Stevens-Johnson syndrome, antibiotics may be used to prevent or treat secondary infections, but the choice of antibiotic is not explicitly stated in the provided evidence 1.
Key differences in treatment
- DRESS syndrome: focus on withdrawing the offending drug and supportive care, with antibiotics used only if a secondary infection is present
- Stevens-Johnson syndrome: emphasis on wound management, supportive care, and prevention of secondary infections, with antibiotics used as needed, but no specific recommendations are provided in the evidence 1 ### Antibiotic selection When antibiotics are necessary, the choice should be guided by the suspected or confirmed pathogen, as well as local antimicrobial resistance patterns. However, the evidence does not provide specific recommendations for antibiotic selection in either DRESS syndrome or Stevens-Johnson syndrome 1.
Supportive care
In both conditions, supportive care, including wound management, fluid replacement, and nutritional support, is crucial. In Stevens-Johnson syndrome, prophylactic anticoagulation with low molecular weight heparin and gastric protection with a proton pump inhibitor may be necessary, as outlined in the guidelines 1.
From the Research
Treatment of DRESS Syndrome
The treatment of DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome typically involves the immediate withdrawal of the culprit drug and administration of systemic corticosteroids 2, 3, 4.
- The most frequent offending drugs include dapsone, vancomycin, carbamazepine, and antiepileptics 2, 3.
- Clinical findings may include rash, fever, lymphadenopathy, atypical lymphocytes, and hepatic involvement 2, 3.
Use of Intravenous Immunoglobulins (IVIG)
In cases where patients are not responsive to systemic steroids, the addition of IVIG may be helpful in hastening recovery 2, 3.
- IVIG treatment has been shown to resolve fever and improve liver enzymes substantially within a short period of time 2, 3.
- The total dosage of IVIG used in these studies was 1-2 g/kg 2, 3.
Comparison with Stevens-Johnson Syndrome
There is no direct comparison between the treatment of DRESS syndrome and Stevens-Johnson syndrome in the provided studies.
- However, it is worth noting that both conditions are severe cutaneous adverse reactions, and the treatment approach may be similar in some cases 5, 4.
- The use of systemic corticosteroids and other immunosuppressants may be considered in the treatment of both conditions 5, 4.
Pulmonary Manifestations
Pulmonary involvement in DRESS syndrome can present with a range of manifestations, from mild cough or dyspnea to acute respiratory distress syndrome (ARDS) 6.