阿奇霉素在心血管疾病患者中合理性应用策略

Reasonable use of azithromycin in treatment of patients with cardiovascular disease

目的探讨在心血管疾病患者中如何安全、合理的使用阿奇霉素,为临床用药提供指导。方法对1例使用阿奇霉素后发生QT间期延长的扩张型心肌病给予停用的患者进行分析,并查阅医院心血管内科2012年8月-2013年7月所有住院患者静脉滴注阿奇霉素的资料,分析其用药合理性。结果停用阿奇霉素后2d,患者未再发作心悸,复查心电图QT间期恢复正常;医院心血管内科使用阿奇霉素共24例,根据合并基础疾病情况20.8%的使用合理、79.2%使用不合理;24例中的高龄患者占33.3%;疗程>5d的占91.7%。结论阿奇霉素抗感染治疗时应注意选择合适的人群,给予恰当的疗程,关注电解质平衡,避免药物相互作用引起的不良反应的增加,摒弃与喹诺酮类药物的联合方案。

OBJECTIVE To explore the use of azithromycin for treatment of the patients with cardiovascular disease in reasonable and safe way so as to provide guidance for clinical use of antibiotics.METHODS A patient with dilat-ed cardiomyopathy at prolonged QT interval,who was treated with azithromycin,was enrolled in the study,then the clinical data of all the patients who were hospitalized the department of cardiovascular medicine for intravenous administration of azithromycin from Aug 2012 to Jul 2013 were reviewed,and the rationality of use of antibiotics was analyzed.RESULTS The patients did not have episodes of palpitations and the electrocardiogram at QT interval returned to normal after discontinuation of azithromycin for two days.Totally 24 patients in the department of car-diovascular medicine used azitromycin,among whom 20.8% used reasonably and 79.2% did not use reasonably, according to the condition of underlying diseases;the elderly patients accounted for 33.3% （24 cases）;the pa-tients with the treatment course more than 5 days accounted for 9 1 .7%.CONCLUSION As azithromycin is pre-scribed for anti-infection treatment,it is necessary to pay attention to the choice of targeted population,give ap-propriate treatment course,focus on electrolyte balance,avoid increase of adverse events induced by interactions of drugs,and abandon combination drug therapy with quinolones.