颅内感染治疗中(去甲)万古霉素相关非速发型过敏反应分析
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摘要
目的分析(去甲)万古霉素在颅内感染患者应用中出现的非速发型过敏反应临床特点。方法回顾2013年9月至2017年9月北京潞河医院神经外科应用(去甲)万古霉素治疗颅内感染患者所出现的非速发型过敏反应,分析其临床表现、处理及转归。结果应用(去甲)万古霉素治疗颅内感染患者34例中,出现非速发型过敏反应患者12例(35.3%),其中男6例、女6例;确认(去甲)万古霉素相关过敏反应2例、疑似10例,平均用药22(11~26)d出现过敏表现。过敏表现为多形性红斑样皮疹(12例)、痒感明显(11例)、寒战(9例)、高热(9例)、嗜酸性粒细胞比例增高(7例)、白细胞减少(5例)和肝功能损害(2例),发展为重症药疹2例。发现过敏后均停用可疑药物,应用糖皮质激素(6例)、丙种球蛋白(2例重症药疹者),过敏反应逐步消退且病情有效控制者10例,家属放弃治疗2例。结论应用(去甲)万古霉素治疗颅内感染,临床存在给药剂量及监测不足、疗程过长等问题,宜早期诊断、按体重个体化足量给药,监测并依据血药浓度调整用药,尽量缩短(去甲)万古霉素经验用药及总疗程,发现过敏反应及时停药并妥善应对,保障用药安全。
Objective To analyze the clinical characteristics of hypersensitivity reactions associated with vancomycin or norvancomycin in patients with intracranial infection. Methods Medical records of hospitalized patients using vancomycin or norvancomycin were reviewed in the department of neurosurgery of Beijing Luhe hospital,Capital Medical University from September 2013 to September 2017. The clinical manifestations,management and outcome of those cases with hypersensitivity reactions were analyzed. Results Among the 34 patients,12 patients( 35. 3%) appeared hypersensitivity reactions associated with vancomycin or norvancomycin. 6 were men,6 were women,mean age was 64( 32-80) years old,mean weight was 70( 45-85) kg. 1 case was confirmed to be associated with vancomycin,another with norvancomycin,10 cases were suspected to be connected with either of the two drugs. Mean incubation period were 22( 11-26) d. They presented maculopapular rash( n = 12 cases),itching( n = 11 cases),fever( n = 9 cases),chills( n = 9 cases),the increased proportion of eosinophils( n = 7 cases),leucopenia( n = 5 cases),liver function damage( n = 2 cases). Two casesdeveloped severe drug eruptions. After withdrawl of the culprit drug in time,administrated glucocorticoid( n = 6 cases)and gamma globulinn( n = 2 cases,severe drug eruptions),10 cases were cured,2 cases were given up by their relatives. Conclusion To optimize the outcome of vancomycin or norvancomycin administration in the treatment of intracranial infection,early adequate dose and adjusting according to the drug serum concentration are preferable. To ensure a safe and effective use of the drug,the culprit drugs should be withdrawn timely and appropriate treatments should be given accordingly,once drug hypersensitive reactions are found.
Objective To analyze the clinical characteristics of hypersensitivity reactions associated with vancomycin or norvancomycin in patients with intracranial infection. Methods Medical records of hospitalized patients using vancomycin or norvancomycin were reviewed in the department of neurosurgery of Beijing Luhe hospital,Capital Medical University from September 2013 to September 2017. The clinical manifestations,management and outcome of those cases with hypersensitivity reactions were analyzed. Results Among the 34 patients,12 patients( 35. 3%) appeared hypersensitivity reactions associated with vancomycin or norvancomycin. 6 were men,6 were women,mean age was 64( 32-80) years old,mean weight was 70( 45-85) kg. 1 case was confirmed to be associated with vancomycin,another with norvancomycin,10 cases were suspected to be connected with either of the two drugs. Mean incubation period were 22( 11-26) d. They presented maculopapular rash( n = 12 cases),itching( n = 11 cases),fever( n = 9 cases),chills( n = 9 cases),the increased proportion of eosinophils( n = 7 cases),leucopenia( n = 5 cases),liver function damage( n = 2 cases). Two casesdeveloped severe drug eruptions. After withdrawl of the culprit drug in time,administrated glucocorticoid( n = 6 cases)and gamma globulinn( n = 2 cases,severe drug eruptions),10 cases were cured,2 cases were given up by their relatives. Conclusion To optimize the outcome of vancomycin or norvancomycin administration in the treatment of intracranial infection,early adequate dose and adjusting according to the drug serum concentration are preferable. To ensure a safe and effective use of the drug,the culprit drugs should be withdrawn timely and appropriate treatments should be given accordingly,once drug hypersensitive reactions are found.
引文
[1]中华医学会神经外科学分会.中国神经外科重症患者感染诊治专家共识(2017)[J].中华医学杂志,2017,97(21):1607-1614.
[2]魏庆宇,李金生.药物过敏国际共识(2014版)解读[J].医学与哲学,2015,36(7):31-34.
[3]DEMOLY P,ADKINSON N F,BROCKOW K,et al.International consensus on drug allergy[J].Allergy,2014,69(4):420-437.
[4]舒畅,渠涛,贾力,等.药物超敏反应综合征临床分析[J].中华医学杂志,2014,94(30):2366-2368.
[5]HIRANSUTHIKUL A,RTANANUPONG T,KLAEWSONGKRAM J,et al.Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms(DIHS/DRESS).11 years retrospective study in Thailand[J].Allergy Int,2016,65(4):432-438.
[6]TUNKEL A R,HASBUN R,BHIMRAJ A,et al.2017 infectious diseases society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis[J/OL].Clin Infect Dis,2017,64(6):e34–e65.2017-02-14[2017-12-12].https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw861.
[7]万古霉素临床应用剂量专家组.万古霉素临床应用剂量中国专家共识[J].中华传染病学杂志,2012,30(11):641-646.
[8]焦蕊,解染,翟所迪.万古霉素个体化给药方法与临床结局相关性的Meta分析[J].中国临床药理学杂志,2015,31(13):1353-1357.
[9]盛晓燕,高菲菲,马陵悦,等.万古霉素在老年患者中的临床用药调查分析[J].中国临床药理学杂志,2015,31(24):2451-2453.
[10]郝京京,史中华,陈晗,等.万古霉素治疗神经外科术后中枢神经系统感染:一项针对处方剂量的回顾性调查[J].中华危重病急救医学,2016,28(7):629-633.
[11]CHEN K,WU Y,WANG Q,et al.The methodology and pharmacokinetics study of intraventricular administration of vancomycin in patients with intracranial infections after craniotomy[J/OL].J Crit Care,2015,30(1):218.e1-5.2014-10-02[2017-12-12].http://linkinghub.elsevier.com/retrieve/pii/S0883-9441(14)00403-1.
[12]BRUNIERA F R,FERREIRA F M,SAVIOLLI L R,et al.The use of vancomycin with its therapeutic and adverse effects:a review[J].Eur Rev Med Pharmacol Sci,2015,19(4):694-700.
[2]魏庆宇,李金生.药物过敏国际共识(2014版)解读[J].医学与哲学,2015,36(7):31-34.
[3]DEMOLY P,ADKINSON N F,BROCKOW K,et al.International consensus on drug allergy[J].Allergy,2014,69(4):420-437.
[4]舒畅,渠涛,贾力,等.药物超敏反应综合征临床分析[J].中华医学杂志,2014,94(30):2366-2368.
[5]HIRANSUTHIKUL A,RTANANUPONG T,KLAEWSONGKRAM J,et al.Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms(DIHS/DRESS).11 years retrospective study in Thailand[J].Allergy Int,2016,65(4):432-438.
[6]TUNKEL A R,HASBUN R,BHIMRAJ A,et al.2017 infectious diseases society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis[J/OL].Clin Infect Dis,2017,64(6):e34–e65.2017-02-14[2017-12-12].https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciw861.
[7]万古霉素临床应用剂量专家组.万古霉素临床应用剂量中国专家共识[J].中华传染病学杂志,2012,30(11):641-646.
[8]焦蕊,解染,翟所迪.万古霉素个体化给药方法与临床结局相关性的Meta分析[J].中国临床药理学杂志,2015,31(13):1353-1357.
[9]盛晓燕,高菲菲,马陵悦,等.万古霉素在老年患者中的临床用药调查分析[J].中国临床药理学杂志,2015,31(24):2451-2453.
[10]郝京京,史中华,陈晗,等.万古霉素治疗神经外科术后中枢神经系统感染:一项针对处方剂量的回顾性调查[J].中华危重病急救医学,2016,28(7):629-633.
[11]CHEN K,WU Y,WANG Q,et al.The methodology and pharmacokinetics study of intraventricular administration of vancomycin in patients with intracranial infections after craniotomy[J/OL].J Crit Care,2015,30(1):218.e1-5.2014-10-02[2017-12-12].http://linkinghub.elsevier.com/retrieve/pii/S0883-9441(14)00403-1.
[12]BRUNIERA F R,FERREIRA F M,SAVIOLLI L R,et al.The use of vancomycin with its therapeutic and adverse effects:a review[J].Eur Rev Med Pharmacol Sci,2015,19(4):694-700.