1例细菌性扁桃体炎抗菌药物应用分析
|
摘要
1例32岁年轻患者,高热伴咽痛1d,查体可见咽部充血,双侧扁桃体Ⅱ度肿大,伴较多白色脓性点状渗出,血白细胞、C-反应蛋白明显升高,甲型/乙型流感病毒检测阴性,明确诊断为细菌性扁桃体炎。根据我国细菌耐药性监测结果,细菌性扁桃体炎应首选青霉素类抗菌药物治疗,二线治疗方案为一代或二代头孢菌素类抗菌药物。本病例中存在抗菌药物应用不合理,临床诊疗中应根据相关指南及规范合理应用抗菌药物。
A 32-year-old young patient with hyperthermia and sore pharynx showed hyperemia in pharynx,Ⅱ degree enlargement of bilateral tonsil,lots of white pyogenic punctate exudation,significantly increase of the white blood leukocyte and C-reactive protein,and negative detection of influenza A/B virus.Bacterial tonsillitis diagnosis was definite.According to the monitoring results of bacterial drug resistance in China,penicillins should be the first choice in the treatment of bacterial tonsillitis,and the second line therapy is the first or second generation cephalosporins.There was unreasonable use of antibiotics in this case.Rational use of antibiotics in clinical diagnosis and treatment should be based on relevant guidelines and norms.
A 32-year-old young patient with hyperthermia and sore pharynx showed hyperemia in pharynx,Ⅱ degree enlargement of bilateral tonsil,lots of white pyogenic punctate exudation,significantly increase of the white blood leukocyte and C-reactive protein,and negative detection of influenza A/B virus.Bacterial tonsillitis diagnosis was definite.According to the monitoring results of bacterial drug resistance in China,penicillins should be the first choice in the treatment of bacterial tonsillitis,and the second line therapy is the first or second generation cephalosporins.There was unreasonable use of antibiotics in this case.Rational use of antibiotics in clinical diagnosis and treatment should be based on relevant guidelines and norms.
引文
[1]Bartlett A,Bola S,Williams R.Acute tonsillitis and its complications:an overview[J].J R Nav Med Serv,2015,101(1):69-73.
[2]Mclsaac W J,Goel V,To T,et al.The validity of a sore throat score in family practice[J].CMAJ,2000,163(7):811-815.
[3]中华医学会,中国医院管理学会药事管理专业委员会,中国药学会医院药学专业委员会.抗菌药物临床应用原则[J].中华医学杂志,2016,84(22):1857-1862.
[4]中国医师协会儿科医师分会儿童耳鼻咽喉专业委员会.儿童急性扁桃体炎诊疗:临床实践指南(2016年制定)[J].中国实用儿科杂志,2017,32(3):161-164.
[5]肖永红,王进,赵彩云,等.2006-2007年Mohnarin细菌耐药监测[J].中华医院感染学杂志,2008,18(8):1051-1056.
[6]国家卫生计生委合理用药专家委员会,全国细菌耐药监测网.2015年全国细菌耐药报告[J].中国职业药师,2016,13(3):3-8.
[7]张委,柳爱青,常峥,等.2016年北京市海淀医院细菌耐药性监测[J].标记免疫分析与临床,2018,25(7):946-952.
[8]吴琼,曾婷,王全意,等.儿童A族链球菌emm分型变迁与大环内酯类耐药的关系[J].中国现代医学杂志,2014,24(27):18-23.
[9]李耘,吕媛,薛峰,等.卫生部全国细菌耐药监测网(Mohnarin)2011-2012年革兰阳性菌耐药监测报告[J].中国临床药理学杂志,2014,21(3):260-277.
[10]项光早,陈伟军,熊国锋,等.温州地区2010至2014年扁桃体周围脓肿病原菌分布及耐药性变迁[J].中华临床感染病杂志,2018,8(4):311-316.
[11]Windfuhr J P,Toepfner N,Steffen G,et al.Clinical practice guideline:tonsillitis I.Diagnostics and nonsurgical management[J].Eur Arch Otorhinolaryngol,2016,273(4):973-987.
[12]国家药品监督管理局.第二批化学药品说明书目录:药监注函[2002]58号[EB/OL].(2002-02-05)[2019-01-12].http://law.pharmnet.com.cn/upload/03 12161535261029.doc.
[13]张婴元,汪复,张菁,等.头孢菌素类的临床药物动力学研究及给药方案的制订[J].中华传染病杂志,1995,13(4):195-198.
[2]Mclsaac W J,Goel V,To T,et al.The validity of a sore throat score in family practice[J].CMAJ,2000,163(7):811-815.
[3]中华医学会,中国医院管理学会药事管理专业委员会,中国药学会医院药学专业委员会.抗菌药物临床应用原则[J].中华医学杂志,2016,84(22):1857-1862.
[4]中国医师协会儿科医师分会儿童耳鼻咽喉专业委员会.儿童急性扁桃体炎诊疗:临床实践指南(2016年制定)[J].中国实用儿科杂志,2017,32(3):161-164.
[5]肖永红,王进,赵彩云,等.2006-2007年Mohnarin细菌耐药监测[J].中华医院感染学杂志,2008,18(8):1051-1056.
[6]国家卫生计生委合理用药专家委员会,全国细菌耐药监测网.2015年全国细菌耐药报告[J].中国职业药师,2016,13(3):3-8.
[7]张委,柳爱青,常峥,等.2016年北京市海淀医院细菌耐药性监测[J].标记免疫分析与临床,2018,25(7):946-952.
[8]吴琼,曾婷,王全意,等.儿童A族链球菌emm分型变迁与大环内酯类耐药的关系[J].中国现代医学杂志,2014,24(27):18-23.
[9]李耘,吕媛,薛峰,等.卫生部全国细菌耐药监测网(Mohnarin)2011-2012年革兰阳性菌耐药监测报告[J].中国临床药理学杂志,2014,21(3):260-277.
[10]项光早,陈伟军,熊国锋,等.温州地区2010至2014年扁桃体周围脓肿病原菌分布及耐药性变迁[J].中华临床感染病杂志,2018,8(4):311-316.
[11]Windfuhr J P,Toepfner N,Steffen G,et al.Clinical practice guideline:tonsillitis I.Diagnostics and nonsurgical management[J].Eur Arch Otorhinolaryngol,2016,273(4):973-987.
[12]国家药品监督管理局.第二批化学药品说明书目录:药监注函[2002]58号[EB/OL].(2002-02-05)[2019-01-12].http://law.pharmnet.com.cn/upload/03 12161535261029.doc.
[13]张婴元,汪复,张菁,等.头孢菌素类的临床药物动力学研究及给药方案的制订[J].中华传染病杂志,1995,13(4):195-198.