{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T09:14:26Z","timestamp":1793006066543,"version":"4.5.0"},"reference-count":49,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2016,10,1]],"date-time":"2016-10-01T00:00:00Z","timestamp":1475280000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:p>\n                    <jats:bold>Objective:<\/jats:bold>\n                    To provide an extensive review of case reports, epidemiological data, and the underlying mechanism of antibiotic-induced skin rash in patients with concurrent infectious mononucleosis (IM).\n                    <jats:bold>Data Sources:<\/jats:bold>\n                    A MEDLINE literature search inclusive of the dates 1946 to June 2016 was performed using the search terms\n                    <jats:italic toggle=\"yes\">anti-bacterial agents<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">infectious mononucleosis<\/jats:italic>\n                    . EMBASE (1980 to June 2016) was searched using the terms\n                    <jats:italic toggle=\"yes\">mononucleosis<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">antibiotic agent<\/jats:italic>\n                    and\n                    <jats:italic toggle=\"yes\">drug eruption<\/jats:italic>\n                    . References of all relevant articles were reviewed for additional citations and information.\n                    <jats:bold>Study Selection and Data Extraction:<\/jats:bold>\n                    We selected English-language, primary literature, review articles, and mechanistic articles that addressed antibiotic-induced skin rash in patients with concurrent IM. We assessed all case reports available for causality utilizing a modified Naranjo nomogram specifically designed for this subject. We assembled the available epidemiological data into tables to identify trends in incidence rates over the years.\n                    <jats:bold>Data Synthesis:<\/jats:bold>\n                    We identified 17 case reports of antibiotic-associated rash in patients with IM. The median Naranjo score was 6 (range = 1 to 8). The top 3 reported drugs were ampicillin, azithromycin, and amoxicillin. Incidence of this adverse effect was higher in the 1960s (55.6%, 45%, and 33%) than in 2013 (33% and 15%). The mechanism most commonly proposed is a transient virus-mediated immune alteration that sets the stage for loss of antigenic tolerance and the development of a reversible, delayed-type hypersensitivity reaction to the antibiotic.\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    A reassessment of the long-held belief of the high incidence (80%-100%) of antibiotic-induced skin rash in patients with IM seems prudent. Additional studies will be necessary to clarify this issue.\n                  <\/jats:p>","DOI":"10.1177\/1060028016669525","type":"journal-article","created":{"date-parts":[[2016,9,12]],"date-time":"2016-09-12T21:20:26Z","timestamp":1473715226000},"page":"154-162","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":60,"title":["Antibiotic-Induced Rash in Patients With Infectious Mononucleosis"],"prefix":"10.1177","volume":"51","author":[{"given":"Dennis F.","family":"Thompson","sequence":"first","affiliation":[{"name":"Southwestern Oklahoma State University, Weatherford, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carroll L.","family":"Ramos","sequence":"additional","affiliation":[{"name":"Southwestern Oklahoma State University, Weatherford, OK, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,10]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.2111."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1001116."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-4377-0755-7.00246-3"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1951.03810020003001"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(49)80150-8"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-31-4-678"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.40.5.910"},{"key":"e_1_3_2_9_2","article-title":"Hypersensitivity reactions to antibacterial drugs in infectious mononucleosis","volume":"2","author":"Pullen H","year":"1967","unstructured":"Pullen H, Wright N, Murdoch JM. 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