22例替考拉宁致药物热上报病例及文献分析

Drug Fever Induced by Teicoplanin:22 Cases Reports and Literature Analysis

目的为临床及时判断使用替考拉宁(TEC)后可能出现的药物热提供参考。方法基于鼓楼医院2015年1月至2020年5月上报的TEC致药物热不良反应报告,以及检索中国知网(CNKI)、万方数据库、维普数据库和PubMed等数据库2006年1月至2020年12月发表的TEC致药物热的个案报道,分析病例的临床特点。结果共纳入22例患者,其中男多于女(1.75∶1);年龄以40岁以上居多(16例,72.73%);药物热一般发生在给药后第7~15天;除5例不详外,大多数患者以高度发热(39.1~41.0℃)为主(10例,45.45%),且主要伴畏寒、寒战和皮疹等症状;白细胞计数下降或无显著变化11例(6例未查),C反应蛋白(CRP)水平上升10例(10例未查)。经停药或对症处理后,大多数患者(90.91%)体温均下降或恢复正常。结论TEC致药物热诊断困难,临床医师和药师要充分了解药物热相关知识,根据患者临床症状及时停用或更换药物,促进抗菌药物合理使用。

Objective To provide a reference for the clinical diagnosis of possible teicoplanin(TEC)-induced drug fever.Methods Based on the adverse drug reaction reports of TEC-induced drug fever reported by the Drum Tower Hospital from January 2015 to May 2020,and the case reports of TEC-induced drug fever in CNKI,WanFang,VIP and PubMed database published from January 2006 to December 2020 were searched to analyze the clinical characteristics of the cases.Results A total of 22 patients were selected,males were more than females(1.75∶1).Most of the patients were over 40 years old(16 cases,72.73%).Drug fever generally occurred within 7-15 d after administration.Except for five unknown cases,most patients(10 cases,45.45%)had a high fever(39.1-41.0℃),mainly accompanied by chills,chills and rashes.The white blood cell count(WBC)decreased or had no significant change in 11 cases(another six cases were not examined),and the level of C-reactive protein(CRP)increased in 10 cases(10 cases were not examined).After drug withdrawal or symptomatic treatment,the body temperature of most patients(90.91%)decreased or returned to normal.Conclusion The clinical diagnosis of TEC-induced drug fever is difficult.Clinicians and pharmacists should fully understand the relevant knowledge of drug fever,stop or replace drugs in time according to the clinical symptoms of patients,and promote the rational use of antibiotics.