基于药品说明书对β-内酰胺类抗生素皮肤过敏试验临床意义的探讨和建议

Discussion and suggestion about the clinical significance of the dermal sensitivity test of β-lactam antibiotics based on dispensatory

目的通过探讨β-内酰胺类抗生素变态反应发生的机制和皮肤敏感试验(简称皮试)国内外现状,为临床安全合理应用β-内酰胺类抗生素提供参考。方法收集我院现应用的44个品规β-内酰胺类抗生素的药品说明书,对其中的皮试警示内容进行归纳统计;同时查阅国内外文献和共识对当前的β-内酰胺类抗生素的皮试研究进展进行了解。结果我院目前应用的β-内酰胺类抗生素44个品规的药品说明书中,明确要求用药前皮试的有青霉素类药物9个品规,头孢菌素类1个品规,占22.72%,建议皮试有口服青霉素类1个品规、注射用头孢菌素类3个品规,占9%,其余的青霉素类2个品规、头孢菌素类25个品规、碳青霉素类3个品规,共30个品规未注明皮试要求,占68.18%,明确列出皮试方法的仅有注射用青霉素钠1个品规;目前青霉素类的致敏机制非常清楚,和皮试方法有统一的行业规范和标准,而头孢菌素类的皮试必要性,多数研究结果认为无意义,而且缺乏相关的法律规范和统一的行业标准。结论为降低使用β-内酰胺类抗生素过敏的风险,建议严格遵循药品说明书的要求和结合患者的过敏史等综合情况考虑是否进行皮试,全程严密观察并且做好防范救治措施。

Objective To explore the mechanism of allergic reaction ofβ-lactam antibiotics and the current status of the dermal sensitivity test(hereinafter referred to as intradermal test)at home and abroad,and to provide references for safe and rational use ofβ-lactam antibiotics clinically.Methods 44 dispensatories ofβ-lactam antibiotics currently used in our hospital were collected,and the contents about intradermal test warnings were summarized and analyzed.In addition,the domestic and foreign literatures and consensus were reviewed to understand the current research progress of intradermal test ofβ-lactam antibiotics.Results Among 44 dispensatories ofβ-lactam antibiotics currently used in our hospital,it was clearly required that intradermal test should be performed before medication in 9 dispensatories of penicillin and 1 of cephalosporins,accounting for 22.72%.It was recommended that intradermal test should be performed before medication in 1 dispensatory of oral penicillin and 3 dispensatories of cephalosporin for injection,accounting for 9%.It was not indicated whether intradermal test should be performed before medication in the remaining 30 dispensatories,including 2 of penicillin,25 of cephalosporin,and 3 of carbapenem,accounting for 68.18%.Only 1 dispensatory of penicillin sodium for injection clearly specified the intradermal test method.The sensitization mechanism of penicillin was very clear and there were uniform industry norms and standards for intradermal test methods.However,the necessity of intradermal test of cephalosporins was considered to be meaningless in most research results,and there were a lack of relevant legal norms and uniform industry standards.Conclusion In order to reduce the risk of allergies caused by the use ofβ-lactam antibiotics,it is recommended to strictly follow the requirements of the dispensatories combined with the patient's allergy history and other comprehensive conditions when considering whether to conduct the intradermal test,and should observe the whole process closely and take preventive measures.