Clinical Characteristics, Treatment, and Prognosis of Amoxicillin-Induced AGEP/ALEP

Background. Amoxicillin was associated with acute generalized exanthematous pustulosis (AGEP), and the clinical characteristics were not clear. The purpose of this study was to explore the clinical characteristics of amoxicillin-induced AGEP and to provide a basis for prevention and treatment. Methods. Case reports and case series of amoxicillin-induced AGEP were collected for retrospective analysis by searching the Chinese and English databases from inception to January 31, 2023. Results. A total of 46 patients were included with a median age of 40 years (range 1.4, 87). The onset time of AGEP ranged from 6 hours to 28 days, with a median of 2.5 days. Fever occurred in 32 patients (69.6%), and pruritus occurred in 13 patients (28.3%). Ten patients (21.7%) had mucous membrane involvement and systemic involvement, respectively. Twenty-two patients had elevated neutrophils, with a median of 12850/mm³ (range 7880, 29140). Skin biopsy mainly showed subcorneal pustules (22 cases, 47.8%), spongy pustules (14 cases, 30.4%), and inflammatory cell infiltration (26 cases, 56.5%). Skin lesions disappeared in a median of 10 days (range 2, 42) after discontinuation of amoxicillin and administration of topical steroids (26 cases, 56.5%) as well as systemic corticosteroids (13 cases, 28.3%). Conclusions. AGEP is a rare complication of amoxicillin and is self-limiting. Clinicians should correctly identify AGEP and should avoid represcribing amoxicillin. Clinicians should correctly identify AGEP and avoid represcribing amoxicillin, which can prevent unnecessary treatment measures.