Which medications in the drug class Antibiotics are used in the treatment of Toxic Epidermal Necrolysis (TEN)?

Updated: Jul 01, 2021
  • Author: Samantha P Jellinek-Cohen, PharmD, BCPS (AQ-ID); Chief Editor: Michael Stuart Bronze, MD  more...
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Patients with TEN lose their epidermis, a major barrier to invading organisms. If patients become infected, morbidity is enhanced. Staphylococcus aureus is the main bacterium present during the first days, with gram-negative strains appearing later.

Case reports of Klebsiella species, [58] Escherichia coli, and Pseudomonas species recovered from patients with TEN have created concern about the possible polymicrobial nature of sepsis associated with this condition. Therefore, good gram-negative coverage may be necessary.


Nafcillin covers most common skin organisms (eg, Staphylococcus, Streptococcus). If patient has allergy to penicillin or if methicillin-resistant S aureus (MRSA) is present on skin culture, use vancomycin.


Gentamicin is an aminoglycoside antibiotic for gram-negative coverage. It is used in combination with both an agent against gram-positive organisms and one that covers anaerobes. Third-generation cephalosporins, such as ceftazidime, and others with good gram-negative coverage are suitable alternatives. Adjust dose based on renal insufficiency.

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