Respiratory infection management when clinical pneumonia
Macrolide option
Azithromycin PO
500 mg PO once then 250 mg PO daily for 4 days
QT risk screening
Alternative option
Doxycycline PO
100 mg PO twice daily for 7 to 10 days
Pregnancy avoidance
Ocular involvement
Eye protection steps
Preservative-free artificial tears
1 to 2 drops every 2 to 4 hours
If conjunctivitis or epithelial defect, urgent ophthalmology
Topical antibiotic decisions by ophthalmology
Symblepharon prevention strategies by ophthalmology
Evidence and guideline framing
Expert consensus framing
Immediate discontinuation of suspected culprit drug for severe mucocutaneous reactions (Class I consensus)
Early dermatology and ophthalmology involvement for mucosal disease (Class I consensus)
Antiviral suppression for recurrent HSV-associated EM (Class IIa consensus)
Special Populations
Pregnancy
Pregnancy-specific considerations
Trigger profiling
Medication exposure review
Infection screening threshold lower
Medication safety
Avoid doxycycline
Valacyclovir acceptable when indicated
Disposition threshold
Lower threshold for admission with poor intake
Geriatric
Older adult considerations
Polypharmacy risk
Higher probability of drug-triggered severe reactions
Dehydration vulnerability
Lower reserve with mucositis
Renal dosing
Antiviral dose adjustment need
Pediatrics
Pediatric considerations
Common triggers
HSV
Mycoplasma pneumoniae
Weight-based dosing
Acyclovir dosing per kg with pediatric references
Avoid adult fixed dosing without weight check
Admission threshold lower
Oral intake risk
Caregiver ability to monitor
Background
Epidemiology
Frequency patterns
EM often infection-associated
HSV most common trigger in recurrent EM
Mycoplasma pneumoniae associated in some cases
Drug-triggered EM less common than drug-triggered SJS/TEN
Typical demographics
Any age
Recurrent cases often younger patients
Pathophysiology
Immunologic mechanism
Cell-mediated hypersensitivity pattern
Interface dermatitis
Keratinocyte injury
HSV-associated pathway concept
Viral antigen driven immune response
Clinical consequence mapping
Target lesion formation
Central necrosis and inflammation pattern
Mucosal erosions
Epithelial injury and inflammation
Therapeutic Considerations
Supportive care rationale
Self-limited course common in EM minor
Symptom control improves intake and comfort
Antiviral rationale
HSV suppression reduces recurrence frequency in HSV-associated recurrent EM
Corticosteroid rationale and caution
Potential benefit for severe mucositis symptoms
Infection risk and diagnostic masking risk
SJS/TEN separation importance
Different prognosis
Different level of care requirements
Patient Discharge Instructions
copy discharge instructions
Home care plan
Skin care
Fragrance-free moisturizer multiple times daily
Cool compresses for discomfort
Itch and pain plan
Cetirizine as directed
Acetaminophen as directed
Mouth care if sores
Saline rinses
Soft foods and fluids
Medication safety plan
Avoid suspected trigger medication
Provide medication list to every clinician until clarified
Follow-up plan
Primary care within 48 to 72 hours
Dermatology referral if recurrent, severe, or uncertain diagnosis
Ophthalmology follow-up if any eye symptoms
Return immediately for red flags
Trouble breathing
Trouble swallowing or drooling
Rapidly spreading rash
Skin pain or tenderness worsening
Blistering or skin peeling
Eye pain, light sensitivity, or vision change
Unable to drink enough fluids or decreased urination
Fever with feeling very unwell
References
Clinical guidelines and evidence sources
Source list
Dermatology and emergency medicine reviews on erythema multiforme and SJS/TEN differentiation
Target lesion morphology definitions
Management emphasis on supportive care and trigger treatment
HSV-associated recurrent EM antiviral suppression evidence summaries
Valacyclovir and acyclovir suppressive regimens
Recurrence reduction outcomes in recurrent EM cohorts
Severe cutaneous adverse reaction resources
SCORTEN prognostic tool for SJS/TEN
Burn unit level care standards for epidermal detachment
Clinical management system formatting specification
Checkbox-only formatting rules
Section structure requirements
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.