哌拉西林他唑巴坦钠联用甲硝唑致白细胞、粒细胞减少一例并文献复习

A case report of leukopenia and neutropenia induced by combined use of piperacillin/tazobactam and metronidazole and literature review

目的探讨哌拉西林他唑巴坦和甲硝唑联合治疗肺脓肿的必要性,以及联用时引起白细胞、粒细胞减少的诊治经验,以提高对其引起的药物不良反应的认识。方法结合1例哌拉西林他唑巴坦钠联用甲硝唑抗感染治疗出现白细胞、粒细胞减少的临床案例,分析肺脓肿治疗方案,检索国内外哌拉西林他唑巴坦和甲硝唑导致白细胞、粒细胞减少的文献,共收集到相关文献16篇,并从给药方案、不良反应表现等方面对文献进行分析。结果哌拉西林他唑巴坦和甲硝唑的厌氧菌敏感性相当,二者不必联用。哌拉西林他唑巴坦和甲硝唑均可引起白细胞、粒细胞减少的不良反应,甲硝唑引起此不良反应的规律尚不明确,哌拉西林他唑巴坦使用疗程长、累积剂量大时更容易引起白细胞、粒细胞减少的不良反应。结论药师参与临床治疗,有助于不良反应的及时发现和处理,确保用药安全有效。

Objective To explore the necessity of combined use of piperacillin/tazobactam and metronidazole for treating lung abscess and the experience in the diagnosis and treatment of leukopenia and neutropenia caused by the treatment,in order to improve the understanding of the adverse reactions.Methods A clinical case of leukopenia and neutropenia induced by combined use of piperacillin/tazobactam and metronidazole was analyzed,the therapeutic scheme of lung abscess was analyzed,and domestic and foreign literatures on these side effects induced by the two drugs were retrieved.A total of 16 related literatures were collected and analyzed concerning drug delivery regimen and adverse reactions.Results Both drugs were sensitive to anaerobes,and also can cause the adverse reaction of leukopenia and neutropenia.There was no need of combined use of them.The rule of the adverse reactions caused by metronidazole was unclear.On the other hand,with long course and large cumulative dose of piperacillin/tazobactam treatment,it was more likely to lead to leukopenia and neutropenia.Conclusion Pharmacist's participation in clinical practice,can help the diagnosis and treatment of adverse reaction and ensure the safety of drug use.