阿莫西林-舒巴坦致老年患者急性间质性肾炎2例

Acute interstitial nephritis caused by amoxicillin/sulbactam in 2 elderly patients

2例老年女性患者(年龄80、74岁)分别因慢性支气管炎急性发作和皮肤感染给予阿莫西林-舒巴坦6.0 g加入0.9℅氯化钠注射液250 mL,1次/d静脉滴注。例1于次日出现尿频、尿痛、排尿困难,肉眼血尿2,4 h尿量约400 mL;实验室检查示尿蛋白(+),隐血(+++);BUN 8.48 mmol/L,SCr 380μmol/L。停用阿莫西林-舒巴坦,改为林可霉素,并给予保护肾功能及对症支持治疗。15 d后24 h尿量1 500 mL,BUN 5.86 mmol/L,SCr 116μmol/L,尿常规正常。例2在药物输注完毕后即出现恶心、呕吐、腰痛、血尿;尿蛋白(+++),隐血(++)。停用阿莫西林-舒巴坦,改用林可霉素。症状无好转2,4 h尿量不足200 mL,BUN 11.45 mmol/L,SCr 467μmol/L。行血液透析,林可霉素继续使用,并给予支持及对症治疗。治疗10 d后尿量逐渐增加,22 d后24 h尿量1 200 mL,BUN 7.83 mmol/L,SCr 141μmol/L,尿常规恢复正常。

Two elderly women,aged 80 and 74 years,received an IV infusion of amoxicillin/sulbactam 6.0 g in 0.9% sodium chloride 250 mL once daily for acute attack of chronic bronchitis and skin infection,respectively.Patient 1 experienced urinary frequency,urodynia,dysuria,gross hematuria and 24-hour urine volume was about 400 mL the next day.Laboratory tests showed the following values： urine protein（＋）,occult blood（＋＋＋）,BUN 8.48 mmol/L,SCr 380 μmol/L.Amoxicillin/sulbactam was stopped and changed to lincomycin.Renal function protective,symptomatic,and supportive treatments were also given.Fifteen days later,her 24-hour urine volume was 1 500 mL,her BUN level was 5.86 mmol/L,her SCr level was 116 μmol/L,and routine urine tests were normal.Patient 2 was presented with nausea,vomiting,lumbago,hematuria,three＋urine protein and two＋occult blood after infusion completion.Amoxicillin/sulbactam was withdrawn and switched to lincomycin.Her conditions did not resolve and 24-hour urine volume was less than 200 mL.Her BUN level was 11.45 mmol/L and SCr level was 467 μmol/L.Hemodialysis was performed,lincomycin was continued and supportive and symptomatic treatments were given.Ten days after treatments,her urine volume increased gradually.Twenty-two days later,the 24hour urine volume was 1 200 mL.Meanwhile BUN level and SCr level were respectively 7.83 mmol/L and 141 μmol/L,routine urine tests was within normal range.