β-内酰胺类抗菌药物皮肤过敏试验探讨

Exploration of Skin Allergy Test of β-lactam Antibiotics

目的:为β-内酰胺类抗菌药物使用前是否需作皮肤过敏试验(下简称皮试)提供参考。方法:根据近年国内有关文献报道、药学资料记载及多年的用药经验,从过敏反应发生机制方面对β-内酰胺类抗菌药物是否需作皮试进行分析讨论。结果与结论:β-内酰胺类抗菌药物中的头孢菌素类(下简称头孢类)的β-内酰胺环较青霉素类稳定,所以头孢类过敏反应发生率较低;头孢类各药物间缺乏共同的抗原决定簇,所以头孢类极少发生交叉过敏反应。此外相对于青霉素类,头孢类的皮试符合率太低,因此β-内酰胺类抗菌药物使用前是否作皮试应严格按照规范药品说明书要求执行,青霉素类抗菌药物只需作青霉素皮试,不应盲目扩大β-内酰胺类抗菌药物皮试的品种范围,造成患者不必要的负担。

OBJECTIVE： To provide reference for whether skin allergy test is necessary before the application of β-lactam anti- biotics. METHODS： According to recent reports of domestic related literatures, pharmacy records and drug use experience, whether skin allergy test is necessary before the application of β-lactam antibiotics was discussed in respect of allergic mechanism. RESULTS ＆ CONCLUSIONS： Cephalosporin of β-lactam antibiotics （called cefaclor in short） is more stable than penicillin so it causes less allergic reaction; because cefaclor lacks of common epitopes, it hardly causes cross-allergic reaction. Additionally, skin allergic reaction of cefaclor antibiotics has low coincidence rate, compared with penicillin. The skin allergy test β-lactam antibiotics must be done strictly in accordance with package insets. Penicillin skin allergy test is required for penicillin. The blind expansion of the skin allergy test range of varieties of β-lactam antibiotics should be limited to avoid patients offering the unnecessary costs and suffering.