哌拉西林他唑巴坦钠联用甲硝唑致白细胞、粒细胞减少一例并文献复习
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摘要
目的探讨哌拉西林他唑巴坦和甲硝唑联合治疗肺脓肿的必要性,以及联用时引起白细胞、粒细胞减少的诊治经验,以提高对其引起的药物不良反应的认识。方法结合1例哌拉西林他唑巴坦钠联用甲硝唑抗感染治疗出现白细胞、粒细胞减少的临床案例,分析肺脓肿治疗方案,检索国内外哌拉西林他唑巴坦和甲硝唑导致白细胞、粒细胞减少的文献,共收集到相关文献16篇,并从给药方案、不良反应表现等方面对文献进行分析。结果哌拉西林他唑巴坦和甲硝唑的厌氧菌敏感性相当,二者不必联用。哌拉西林他唑巴坦和甲硝唑均可引起白细胞、粒细胞减少的不良反应,甲硝唑引起此不良反应的规律尚不明确,哌拉西林他唑巴坦使用疗程长、累积剂量大时更容易引起白细胞、粒细胞减少的不良反应。结论药师参与临床治疗,有助于不良反应的及时发现和处理,确保用药安全有效。
Objective To explore the necessity of combined use of piperacillin/tazobactamand metronidazole for treating lung abscess and the experience in the diagnosis and treatment of leukopenia and neutropenia caused by the treatment,in order to improve the understanding of the adverse reactions. Methods A clinical case of leukopenia and neutropenia induced by combined use of piperacillin/tazobactam and metronidazole was analyzed,the therapeutic scheme of lung abscess was analyzed,and domestic and foreign literatures on these side effects induced by the two drugs were retrieved. A total of 16 related literatures were collected and analyzed concerning drug delivery regimen and adverse reactions. Results Both drugs were sensitive to anaerobes,and also can cause the adverse reaction of leukopenia and neutropenia. There was no need of combined use of them. The rule of the adverse reactions caused by metronidazole was unclear. On the other hand,with long course and large cumulative dose of piperacillin/tazobactam treatment,it was more likely to lead to leukopenia and neutropenia. Conclusion Pharmacist's participation in clinical practice,can help the diagnosis and treatment of adverse reaction and ensure the safety of drug use.
Objective To explore the necessity of combined use of piperacillin/tazobactamand metronidazole for treating lung abscess and the experience in the diagnosis and treatment of leukopenia and neutropenia caused by the treatment,in order to improve the understanding of the adverse reactions. Methods A clinical case of leukopenia and neutropenia induced by combined use of piperacillin/tazobactam and metronidazole was analyzed,the therapeutic scheme of lung abscess was analyzed,and domestic and foreign literatures on these side effects induced by the two drugs were retrieved. A total of 16 related literatures were collected and analyzed concerning drug delivery regimen and adverse reactions. Results Both drugs were sensitive to anaerobes,and also can cause the adverse reaction of leukopenia and neutropenia. There was no need of combined use of them. The rule of the adverse reactions caused by metronidazole was unclear. On the other hand,with long course and large cumulative dose of piperacillin/tazobactam treatment,it was more likely to lead to leukopenia and neutropenia. Conclusion Pharmacist's participation in clinical practice,can help the diagnosis and treatment of adverse reaction and ensure the safety of drug use.
引文
[1] Yazbeck MF,Dahdel M,Kalra A,et al. Lung abscess:update on microbiology and management[J]. Am J Ther,2014,21(3):217-221.
[2]中华人民共和国卫生部医政司,卫生部合理用药专家委员会.国家抗微生物治疗指南[M].北京:人民卫生出版社,2012.
[3] Chandorkar G,Huntington JA,Gotfried MH,et al. Intrapulmonary penetration of ceftolozane/tazobactam and piperacillin/tazobactam in healthy adult subjects[J]. J Antimicrob Chemother,2012,67(10):2463-2469.
[4] Yunoki T,Matsumura Y,Yamamoto M,et al. Genetic identification and antimicrobial susceptibility of clinically isolated anaerobic bacteria:a prospective multicenter surveillance study in Japan[J]. Anaerobe,2017,48:215-223.
[5] Lee Y,Park YJ,Kim MN,et al. Multicenter study of antimicrobial susceptibility of anaerobic bacteria in Korea in 2012[J]. Ann Lab Med,2015,35(5):479-486.
[6] Tan TY,Ng LS,Kwang LL,et al. Clinical characteristics and antimicrobial susceptibilities of anaerobic bacteremia in an acute care hospital[J]. Anaerobe,2017,43:69-74.
[7]李光田.甲硝唑致重度白细胞减少2例[J].药物流行病学杂志,1995,(1):48.
[8]李明贤,韩金伦.甲硝唑致高热并白细胞减少2例[J].新医学,2001,32(10):580.
[9] Khan AY,Golewale MH,Kahn DA. A case of chronic drug-induced neutropenia[J]. J Psychiatr Pract,2008,14(4):246-250.
[10] Gutiérrez GM,López LE,Fernández AO,et al. Neutropenia induced by therapeutic doses of intravenous metronidazole[J]. Farm Hosp,2009,33(4):231-233.
[11]罗瑛.头孢甲肟和甲硝唑联用致白细胞下降1例[J].中国执业药师,2014,11(9):51-52.
[12]胡露,彭海兵,郭特鎏.甲硝唑片致白细胞减少1例[J].西南国防医药,2015,25(9):1040.
[13]张赞玲,尹桃.静脉滴注哌拉西林钠-他唑巴坦钠致白细胞、血小板减少1例[J].中南药学,2006,4(6):474.
[14]裴萌,侯伟.哌拉西林钠/他唑巴坦钠致严重粒细胞减少症1例[J].安徽医药,2006,10(8):594.
[15]冯智勇,肖美华,陈文颖.哌拉西林钠-他唑巴坦钠致白细胞减少1例[J].中国中医药资讯,2010,2(22):290.
[16]何忠芳,郑茂华,武新安,等.哌拉西林钠他唑巴坦钠致白细胞减少[J].药物不良反应杂志,2012,14(5):308-309.
[17] He ZF,Wu XA,Wang YP. Severe bone marrow suppression and hepatic dysfunction caused by piperacillin/tazobactam[J]. Scand J Infect Dis,2013,45(11):885-887.
[18] Uzun G,Onem Y,Hatipoglu M,et al. Piperacillin/tazobactaminduced neutropenia,thrombocytopenia,and fever during treatment of a diabetic foot infection[J]. Scand J Infect Dis,2013,45(1):73-76.
[19]刘静,严郁,徐珽.注射用哌拉西林钠他唑巴坦钠致白细胞减少及高热1例[J].中国药业,2015,24(13):95.
[20]苏志德,王光芳,王有森.哌拉西林他唑巴坦钠致严重骨髓抑制1例[J].中国医院药学杂志,2015,35(9):864.
[21] Reichardt P,Handrick W,Linke A,et al. Leukocytopenia,thrombocytopenia and fever related to piperacillin/tazobactam treatment--a retrospective analysis in 38 children w ith cystic fibrosis[J]. Infection,1999,27(6):355-356.
[22]杨媛,张威,毛璐,等.哌拉西林钠他唑巴坦钠致白细胞减少的临床特征分析[J].中国医院药学杂志,2014,34(7):550-552.
[23]周仑.头孢哌酮钠舒巴坦钠导致粒细胞缺乏2例分析[J].中国医院药学杂志,2016,36(14):1230-1231.
[24]樊念念,陈升见,胡芸.头孢哌酮钠舒巴坦钠致粒细胞减少1例[J].实用医学杂志,2009,25(16):2763.
[25]钟晗,郑毅隽,陈璋璋.头孢哌酮/舒巴坦致粒细胞缺乏1例[J].医药导报,2017,36(10):1204-1205.
[26]陈燕.头孢哌酮/舒巴坦引起急性白细胞减少[J].药物不良反应杂志,2004,6(3):182-183.
[27] Berk V,Demiraslan H,Berk E,et al. Moxifloxacin-associated neutropenia[J]. Scand J Infect Dis,2013,45(5):415-416.
[28]罗静,兰安杰,刘丽宏.口服莫西沙星致白细胞及中性粒细胞减少1例[J].中国药物警戒,2012,9(1):58.
[29]万丽娜.莫西沙星致白细胞减少1例分析[J].中国药师,2009,12(3):389.
[2]中华人民共和国卫生部医政司,卫生部合理用药专家委员会.国家抗微生物治疗指南[M].北京:人民卫生出版社,2012.
[3] Chandorkar G,Huntington JA,Gotfried MH,et al. Intrapulmonary penetration of ceftolozane/tazobactam and piperacillin/tazobactam in healthy adult subjects[J]. J Antimicrob Chemother,2012,67(10):2463-2469.
[4] Yunoki T,Matsumura Y,Yamamoto M,et al. Genetic identification and antimicrobial susceptibility of clinically isolated anaerobic bacteria:a prospective multicenter surveillance study in Japan[J]. Anaerobe,2017,48:215-223.
[5] Lee Y,Park YJ,Kim MN,et al. Multicenter study of antimicrobial susceptibility of anaerobic bacteria in Korea in 2012[J]. Ann Lab Med,2015,35(5):479-486.
[6] Tan TY,Ng LS,Kwang LL,et al. Clinical characteristics and antimicrobial susceptibilities of anaerobic bacteremia in an acute care hospital[J]. Anaerobe,2017,43:69-74.
[7]李光田.甲硝唑致重度白细胞减少2例[J].药物流行病学杂志,1995,(1):48.
[8]李明贤,韩金伦.甲硝唑致高热并白细胞减少2例[J].新医学,2001,32(10):580.
[9] Khan AY,Golewale MH,Kahn DA. A case of chronic drug-induced neutropenia[J]. J Psychiatr Pract,2008,14(4):246-250.
[10] Gutiérrez GM,López LE,Fernández AO,et al. Neutropenia induced by therapeutic doses of intravenous metronidazole[J]. Farm Hosp,2009,33(4):231-233.
[11]罗瑛.头孢甲肟和甲硝唑联用致白细胞下降1例[J].中国执业药师,2014,11(9):51-52.
[12]胡露,彭海兵,郭特鎏.甲硝唑片致白细胞减少1例[J].西南国防医药,2015,25(9):1040.
[13]张赞玲,尹桃.静脉滴注哌拉西林钠-他唑巴坦钠致白细胞、血小板减少1例[J].中南药学,2006,4(6):474.
[14]裴萌,侯伟.哌拉西林钠/他唑巴坦钠致严重粒细胞减少症1例[J].安徽医药,2006,10(8):594.
[15]冯智勇,肖美华,陈文颖.哌拉西林钠-他唑巴坦钠致白细胞减少1例[J].中国中医药资讯,2010,2(22):290.
[16]何忠芳,郑茂华,武新安,等.哌拉西林钠他唑巴坦钠致白细胞减少[J].药物不良反应杂志,2012,14(5):308-309.
[17] He ZF,Wu XA,Wang YP. Severe bone marrow suppression and hepatic dysfunction caused by piperacillin/tazobactam[J]. Scand J Infect Dis,2013,45(11):885-887.
[18] Uzun G,Onem Y,Hatipoglu M,et al. Piperacillin/tazobactaminduced neutropenia,thrombocytopenia,and fever during treatment of a diabetic foot infection[J]. Scand J Infect Dis,2013,45(1):73-76.
[19]刘静,严郁,徐珽.注射用哌拉西林钠他唑巴坦钠致白细胞减少及高热1例[J].中国药业,2015,24(13):95.
[20]苏志德,王光芳,王有森.哌拉西林他唑巴坦钠致严重骨髓抑制1例[J].中国医院药学杂志,2015,35(9):864.
[21] Reichardt P,Handrick W,Linke A,et al. Leukocytopenia,thrombocytopenia and fever related to piperacillin/tazobactam treatment--a retrospective analysis in 38 children w ith cystic fibrosis[J]. Infection,1999,27(6):355-356.
[22]杨媛,张威,毛璐,等.哌拉西林钠他唑巴坦钠致白细胞减少的临床特征分析[J].中国医院药学杂志,2014,34(7):550-552.
[23]周仑.头孢哌酮钠舒巴坦钠导致粒细胞缺乏2例分析[J].中国医院药学杂志,2016,36(14):1230-1231.
[24]樊念念,陈升见,胡芸.头孢哌酮钠舒巴坦钠致粒细胞减少1例[J].实用医学杂志,2009,25(16):2763.
[25]钟晗,郑毅隽,陈璋璋.头孢哌酮/舒巴坦致粒细胞缺乏1例[J].医药导报,2017,36(10):1204-1205.
[26]陈燕.头孢哌酮/舒巴坦引起急性白细胞减少[J].药物不良反应杂志,2004,6(3):182-183.
[27] Berk V,Demiraslan H,Berk E,et al. Moxifloxacin-associated neutropenia[J]. Scand J Infect Dis,2013,45(5):415-416.
[28]罗静,兰安杰,刘丽宏.口服莫西沙星致白细胞及中性粒细胞减少1例[J].中国药物警戒,2012,9(1):58.
[29]万丽娜.莫西沙星致白细胞减少1例分析[J].中国药师,2009,12(3):389.