注射用万古霉素致儿童中性粒细胞缺乏1例分析

Analysis of agranulocytosis in a child induced by vancomycin injection

目的为注射用万古霉素引起儿童中性粒细胞减少或缺乏的药品不良反应提供证据。方法分析我院1例4岁感染性心内膜炎患儿应用注射用万古霉素后导致中性粒细胞缺乏的案例,并回顾国内外相关文献。结果检索国内外相关报道并结合本文1例患儿分析,5例患儿在使用注射用万古霉素治疗后均出现不同程度的中性粒细胞减少或缺乏,停药或减量后中性粒细胞逐渐恢复;患儿中性粒细胞减少可能与万古霉素在体内蓄积有关。结论儿童应用注射用万古霉素应严格监测血药浓度,发生药品不良反应时需及时调整剂量或停药;必要时给予对症处置。

Objective To provide reference for vancomycin injection induced adverse reaction—neutropenia/agranulocytosis.Methods A case report of four-year-old girl with agranulocytosis caused by vancomycin injection was analyzed by reviewing the related literature.Results A total of four related domestic and foreign reports were retrieved in this paper.It was found that all the five cases suffered from agranulocytosis or neutropenia to different extents after receiving vancomycin injection,and that the patients gradually recovered after vancomycin withdrawal or dosage reduction.Neutropenia in children might be related to the accumulation of vancomycin.Conclusion Routine plasma drug concentrations should be closely monitored when children receive vancomycin injection.The dosage of vancomycin should be reduced or stopped in case of agranulocytosis or neutropenia.If necessary,symptomatic treatments should be given.