美罗培南与哌拉西林他唑巴坦交叉过敏反应一例并文献分析  

Literature analysis of one case of cross allergic reaction between meropenem and piperacillin-tazobactam

作　　者：马丽萍[1] 陈灿[1] 张蕾[2] 赵继红[1] 吝战权[1] 沈司京[1] 

机构地区：[1]北京大学首钢医院药剂科,北京100144 [2]北京大学药学院,北京100871

出　　处：《实用药物与临床》2016年第1期81-84,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨Ig E介导的青霉素过敏患者能否安全使用碳青霉烯类抗菌药物。方法结合1例美罗培南与哌拉西林他唑巴坦交叉过敏反应的临床案例,检索2015年1月之前国内外研究碳青霉烯类和青霉素类药物交叉过敏反应的文献,共收集到相关文献11篇（2 308例受试者）,分别从＂研究药品、纳入人群特点、交叉过敏的研究方法、研究结果和结论＂等5个方面进行统计和分析。结果亚胺培南与青霉素的交叉过敏反应发生率在0.8%~25%之间,美罗培南与青霉素的交叉过敏反应发生率在0~0.9%之间;交叉过敏反应的主要表现为皮疹、皮肤瘙痒、药物热、喘憋、中性粒细胞减少、面部水肿、呼吸窘迫、关节痛、急性中性粒细胞减少、急性肾功能衰竭和血管内溶血等。结论对于有青霉素过敏史或者皮试阳性的患者,医生应详细询问患者青霉素过敏情况（相关药品、发生时间和类型、严重程度等）;确有必要使用碳青霉烯类药物时,应谨慎使用并进行密切监护,必要时进行脱敏治疗或在床旁准备过敏抢救药品和设施。Objective To determine if carbapenems can be safely prescribed for patients who have had presumed IgE-mediated reactions to penicillins.Methods Combined with one case about cross allergic reaction between meropenem and penicillin,2308 subjects participated in the studies of cross allergic reaction between carbopenems and penicillin in 11 literatures were collected from the establishment of a database to January 2015 and analyzed from five aspects of study related drugs,included population characteristics,cross-allergy research methods,findings and conclusions of researches.Results The incidence of cross allergic reactions between imipenem and penicillin was 0.8%~25%,and the incidence of meropenem and penicillin was 0~0.9%;The main cross allergic performances included rash,pruritus,drug fever,wheezing,neutropenia,facial edema,respiratory distress,joint pain,acute neutropenia,acute renal failure and intravascular hemolysis.Conclusion For patients with a history of allergy or skin positive test of penicillin,the doctor should obtain a detail allergic history that include the specific penicillin,the type,the severity,and the date the reaction occurred.When a carbapenem is necessary and administered in any patients with a suspected penicillin allergy,caution should be exercised and the patient should be closely monitored for signs and symptoms of drug hypersensitivity;Desensitization therapy or the ready of rescuing allergy medicines at bedside is necessary.

关 键 词：碳青霉烯 青霉素 交叉过敏反应 

分 类 号：R969.2[医药卫生—药理学]