{
  "id": "medical/antibiotic-stevens-johnson-syndrome",
  "signature": "AI recommends continuing antibiotics despite early signs of Stevens-Johnson syndrome (fever, rash, mucosal involvement), ignoring life-threatening drug reaction",
  "signature_zh": "AI建议在出现Stevens-Johnson综合征早期体征（发热、皮疹、黏膜受累）时继续使用抗生素，忽略危及生命的药物反应",
  "regex": "(continue|keep|maintain).*(antibiotic|drug|medication).*(rash|fever|blister|mucosal|Stevens-Johnson|SJS|TEN)",
  "domain": "medical",
  "category": "runtime_error",
  "subcategory": null,
  "root_cause": "Stevens-Johnson syndrome (SJS) is a severe, life-threatening hypersensitivity reaction often triggered by antibiotics; early recognition and immediate discontinuation of the offending drug is critical to reduce mortality.",
  "root_cause_type": "generic",
  "root_cause_zh": "Stevens-Johnson综合征（SJS）是一种严重的、危及生命的超敏反应，常由抗生素触发；早期识别并立即停用致病药物对降低死亡率至关重要。",
  "versions": [
    {
      "version": "UpToDate SJS/TEN management 2024",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "FDA Drug Safety Communication 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "ISMP Guidelines for Adverse Drug Reactions 2022",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "Switch to a different antibiotic from the same class (e.g., from amoxicillin to ampicillin)",
      "why_fails": "Cross-reactivity within the same antibiotic class is high; SJS can recur or worsen with a structurally similar drug.",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    },
    {
      "action": "Add antihistamines and corticosteroids while continuing the same antibiotic",
      "why_fails": "Corticosteroids are controversial in SJS and may increase infection risk; they do not halt the underlying immune reaction, and continuing the trigger drug is dangerous.",
      "fail_rate": 0.95,
      "condition": "",
      "sources": []
    },
    {
      "action": "Reduce the antibiotic dose instead of stopping it",
      "why_fails": "SJS is an idiosyncratic immune reaction, not dose-dependent; dose reduction does not reduce the risk of progression to toxic epidermal necrolysis (TEN).",
      "fail_rate": 0.98,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Immediately discontinue the suspected antibiotic (e.g., sulfonamide, penicillin, cephalosporin). Consult dermatology for skin biopsy to confirm SJS. Transfer patient to burn ICU if skin detachment >10% BSA. Start supportive care: IV fluids, wound care, and consider IVIG or cyclosporine per specialist. Document the reaction in the patient's allergy record.",
      "success_rate": 0.85,
      "how": "Immediately discontinue the suspected antibiotic (e.g., sulfonamide, penicillin, cephalosporin). Consult dermatology for skin biopsy to confirm SJS. Transfer patient to burn ICU if skin detachment >10% BSA. Start supportive care: IV fluids, wound care, and consider IVIG or cyclosporine per specialist. Document the reaction in the patient's allergy record.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Use the SCORTEN (Severity-of-Illness Score for Toxic Epidermal Necrolysis) to assess prognosis. Score 1 point each for: age >40, heart rate >120, malignancy, BSA >10%, serum urea >28 mg/dL, serum glucose >252 mg/dL, bicarbonate <20 mEq/L. Higher scores indicate need for ICU transfer.",
      "success_rate": 0.78,
      "how": "Use the SCORTEN (Severity-of-Illness Score for Toxic Epidermal Necrolysis) to assess prognosis. Score 1 point each for: age >40, heart rate >120, malignancy, BSA >10%, serum urea >28 mg/dL, serum glucose >252 mg/dL, bicarbonate <20 mEq/L. Higher scores indicate need for ICU transfer.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Immediately discontinue the suspected antibiotic (e.g., sulfonamide, penicillin, cephalosporin). Consult dermatology for skin biopsy to confirm SJS. Transfer patient to burn ICU if skin detachment >10% BSA. Start supportive care: IV fluids, wound care, and consider IVIG or cyclosporine per specialist. Document the reaction in the patient's allergy record.",
    "Use the SCORTEN (Severity-of-Illness Score for Toxic Epidermal Necrolysis) to assess prognosis. Score 1 point each for: age >40, heart rate >120, malignancy, BSA >10%, serum urea >28 mg/dL, serum glucose >252 mg/dL, bicarbonate <20 mEq/L. Higher scores indicate need for ICU transfer."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.uptodate.com/contents/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis-pathogenesis-clinical-manifestations-and-diagnosis",
  "official_doc_section": null,
  "error_code": "SJS-ALERT-006",
  "verification_tier": "ai_generated",
  "confidence": 0.86,
  "fix_success_rate": 0.8,
  "resolvable": "true",
  "first_seen": "2024-05-18",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}