基于药学监护手段对β-内酰胺类过敏患者使用该类药物的临床研究

Clinical research on the use of β-lactam drugs in allergic patients based on pharmaceutical care

目的 探讨药学监护手段对β-内酰胺类过敏患者使用该类药物(主要是青霉素及头孢菌素类药物)的临床价值。方法 收集2021年10月1日至2022年4月30日我院患者疑似出现β-内酰胺类抗菌药物过敏的患者,采取询问甄别过敏史、判断过敏反应类型、皮试观察、渐进式给药等药学监护手段对其进行评估与治疗。结果 104例可疑β-内酰胺类抗菌药物过敏患者中,4例为既往药物的不良反应;其余100例为过敏患者,经药师会诊后,选定抗感染方案,治疗过程中全程药学监护,按拟定的原则选择侧链结构不同的青霉素或头孢菌素抗感染治疗,避免发生交叉过敏反应。治疗过程中皮试阳性有4例,使用过程出现过敏有5例,均需渐进式给药;100例对β-内酰胺类过敏患者在药学监护下共99例选用该类药物。结论 基于药学监护手段下,根据β-内酰胺类抗菌药物发生交叉过敏的机制,按照拟定的选药方法选择侧链结构不同的青霉素或头孢菌素进行抗感染治疗,避免发生交叉过敏反应,为医务人员处理可疑β-内酰胺类抗菌药物过敏史患者合理用药提供新的思路。

Objective To investigate the clinical value of pharmaceutical care in the use of β-lactam drugs(mainly penicillins and cephalosporins) in patients allergic to β-lactams. Methods The patients with suspected allergy toβ-lactam antibiotics in Chang′an Hospital of Dongguan and Dongguan People’s Hospital from October 1, 2021 to April 30, 2022 were collected, and they were evaluated and treated by means of pharmaceutical monitoring, such as inquiry and screening of allergic history, judgment of allergic reaction type, skin test observation, and progressive administration. Results Among the 104 suspected patients with allergy to β-lactam antibacterial drugs, 4 patients had adverse reactions to previous drugs;the remaining 100 patients were allergic patients. After consultation by a pharmacist, an anti-infection program was selected. During the treatment progress,pharmaceutical care was taken. In principle, penicillins or cephalosporins with different side chain structures were selected for anti-infection treatment to avoid cross-allergic reactions. During the treatment, there were 4 cases with positive skin test and 5 cases with allergic reaction during use, all of which required gradual administration;99cases of 100 patients with β-lactam allergy were selected for this type of drugs under pharmaceutical supervision.Conclusion Based on pharmaceutical care, according to the mechanism of cross-allergy of β-lactam antibiotics,penicillin or cephalosporin with different side chain structure should be selected for anti-infection treatment according to the proposed principles to avoid cross-allergic reaction, which could provide new ideas for medical personnel to deal with the rational use of drugs in patients with suspected allergic history of β-lactam antibiotics.