β-内酰胺类抗菌药物临床交叉过敏反应的发生机制及美国相关处理流程介绍

发布时间：2018-08-04 07:59

【摘要】：目的:了解β-内酰胺类抗菌药物在临床使用中发生交叉过敏反应的机制,为临床合理用药提供参考。方法:结合笔者在美国伊利诺伊大学芝加哥分校(UIC)附属医院进修期间的学习心得,同时根据美国拉什大学医学中心对β-内酰胺类抗菌药物过敏史者的安全用药管理经验,总结β-内酰胺类抗菌药物发生交叉过敏反应的机制,并介绍美国UIC附属医院对β-内酰胺类抗菌药物过敏患者的处理流程。结果:β-内酰胺类抗菌药物发生交叉过敏反应的主要原因是由于药物之间存在相同或相似的侧链,人体内免疫球蛋白E通过识别这些侧链而产生交叉过敏反应。美国UIC附属医院对β-内酰胺类抗菌药物过敏患者的处理流程,包括对患者是否有β-内酰胺类抗菌药物使用指征进行评估,根据评估结果进行规范的青霉素皮试,并采用谨慎渐进式流程用药和快速诱导药物耐受流程进行抗感染治疗。结论:美国UIC附属医院对β-内酰胺类抗菌药物交叉过敏反应患者的处理方法,可为国内临床药师处理可疑β-内酰胺类抗菌药物过敏史者,尤其是针对孕妇、儿童等特殊人群提供新的思路。
[Abstract]:Objective: to understand the mechanism of cross-allergic reaction in clinical use of 尾-lactam antibiotics and to provide reference for rational use of 尾-lactam antibiotics. Methods: based on the experience of the author during his study in the (UIC) affiliated Hospital of the University of Illinois, Chicago, USA, and according to the experience of safe drug administration in patients with history of 尾 -lactam antibiotics allergy at Rush University Medical Center. The mechanism of cross-allergic reaction of 尾-lactam antibiotics was summarized, and the treatment process of 尾-lactam antibiotics allergic patients in UIC affiliated hospital of USA was introduced. Results: the main cause of cross allergic reaction of 尾-lactam antibiotics was the existence of the same or similar side chains between the drugs, and immunoglobulin E produced cross allergic reactions by recognizing these side chains in human body. The treatment process of patients with 尾 -lactam antibiotics allergy in the UIC affiliated Hospital of the United States, including the evaluation of whether the patients have indications for the use of 尾 -lactam antibiotics, and the standard penicillin skin test based on the results of the evaluation. The anti-infective therapy was carried out by careful gradual drug use and rapid induction of drug resistance. Conclusion: the treatment of patients with cross allergic reaction of 尾 -lactam antibiotics in UIC affiliated Hospital of the United States can be used by clinical pharmacists to deal with suspected allergic history of 尾 -lactam antibiotics, especially for pregnant women. Special groups such as children provide new ideas.
【作者单位】：上海交通大学医学院附属新华医院药学部;
【基金】：中国药房杂志社资助
【分类号】：R978.1

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