药师参与多元药物过敏患者围术期抗菌药物品种选择的临床实践

Pharmaceutical Practice of Clinical Pharmacist Involved in Antibiotic Prophylaxis for Surgery in A Patient with Multiple Drug Hypersensitivity

目的为多元药物过敏患者围术期抗菌药物的选用提供参考。方法患者多元药物过敏,既往对莫西沙星、头孢类抗菌药物严重过敏,亚胺培南、阿奇霉素皮试强阳性,临床药师介入后提出使用庆大霉素5 mg·kg-1作为围术期预防用药,采用两步法进行庆大霉素过敏试验以减少假阳性发生率。结果临床选用庆大霉素预防感染,患者围术期无过敏反应发生,亦未出现感染症状,最终顺利出院。结论药物过敏史评估与过敏试验有效性对于多元药物过敏患者抗菌药物选择策略的制定十分重要,庆大霉素可作为该类患者围术期预防用药的替代选择。

OBJECTIVE To provide reference for selection of antibiotic prophylaxis for surgery in patients with multiple drug hypersensitivity （MDH）. METHODS A MDH patient with a history of severe allergic reactions to moxifloxacin and eephalosporin, and positive skin test for imipenem and azithromycin. Clinical pharmacist advised gentamicin for antibiotic prophylaxis using the two-stepmethod for gentamicin skin test to reduce the false positive rate. RESULTS Neither hypersensitivity nor infection was developed during the perioperative period, and the patient was discharged uneventfully. CONCLUSION The drug allergy history and the skin testing are critical in antibiotic selection, and gentamicin can be the alternative for perioperative antibiotic prophylaxis.