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Table 3 Adverse reactions to non beta-lactam antimicrobials: clinical picture and diagnostic tests*

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

Drugs Clinical manifestations Diagnostic tests Drug concentrations
Aminoglycosides CD, U, MPE, FDE, TEN, DIHS, ANA PT 1-20%
STs 0.1 ng/mL-20 mg/mL
Chloramphenicol ANA, fever, U, AE, MPE, AGEP, CD, bullous eruption, EM, FDE, SJS, TEN, bronchospasm, aplastic anemia STs -
PT 1%
Clindamycin MPE, ANA, U, AE, FDE, bullous eruptions, AGEP, Sweet’s syndrome, SJS, DIHS OPT -
PT 10%
Dapsone Methemoglobinemia, agranulocytosis Methemoglobin measurement -
Ethambutol Skin rash, ED, U, AE, EM, SJS, TEN, blood eosinophilia, pulmonary infiltrates, hepatitis, vomiting, thrombocytopenia, flu-like syndrome, arthralgia, neuropsychiatric symptoms, optic neuritis PT 10-50%
Isoniazid MPE, lichenoid rash, flushing, DIHS, SJS, pruritus, drug fever, peripheral neuropathy, hepatitis Graded challenge -
Macrolides U, AE, RC, ANA, MPE, CD, FDE, TEN STs Erythromycin 0.05 mg/mL
Azithromycin 0.01 mg/mL
Roxythromycin 50 mg/mL
Clarithromycin 0.5 mg/mL
PT 10%
OPT -
Pyrazinamide Flushing, itchy rash, ANA, hepatitis STs 500 mg/mL
Quinolones U, ANA, MPE, FDE, photoallergy, AGEP, SJS, TEN STs Levofloxacin 5 mg/mL
Ciprofloxacin 2 mg/mL
Moxifloxacin 1.6 mg/mL
OPT  
Rifampicin Flushing, flu-like syndrome, MPE, pemphigus, lupus erythematosus, SJS, TEN, ANA, thrombocytopenia, nephrotoxicity, hepatitis, hemolytic anemia STs 1: 10000
Streptomycin Skin rash, ANA, ototoxicity, nephrotoxicity, MPE, U, ED, SJS, DIHS PT 20%
Sulphamethoxazole Nausea, haemopoietic disorders, porphyria, ANA, haemolyitc anemia, MPE, SJS, TEN, DIHS STs 80 mg/mL
PT 10%
LTT  
Telithromycin Hepatotoxicity, U, AE, ANA, TEN OPT -
Tetracyclines FDE, DIHS, TEN, hepatitis, pneumonitis, ANA, phototoxic and photallergic reactions STs Doxycicline :prick 20 mg/mL; id: 2 mg/mL
PT 5%
Vancomycin RMS, ANA, SJS, ED, TEN, FDE, vasculitis, DIHS, AGEP, linear IgA bullous dermatosis, nephropathy STs 0.1 mg/mL
   PT 0.005%
  1. *Concentrations given are drawn from the literature. Many of those have not been validated.
  2. Legend: ANA: anaphylaxis; AE: angioedema; CD: contact dermatitis; DIHS: drug-induced hypersensitivity syndrome (DRESS); EM: erythema multiforme; ED: exfoliative dermatitis; FDE: fixed drug eruption; LTT: lymphocyte transformation test; MPE: maculopapular exanthema; OPT: oral provocation test; PT: patch tests; RMS: red man syndrome; RC: rhinoconjunctivitis; SJS: Stevens-Johnson syndrome; STs: skin tests; TEN: toxic epidermal necrolysis; U: urticaria.