抗生素的不良反应(Adverse reactions of antibiotics)由刀豆文库小编整理，希望给你工作、学习、生活带来方便，猜你可能喜欢“抗生素的不良反应”。
抗生素的不良反应（Adverse reactions of antibiotics）Adverse reactions of antibiotics
[Abstract] objective to help clinicians understand the adverse drug reactions of antibiotics and promote rational use of antibiotics in clinic, so as to ensure the safety, effectivene and rationality of the use of antibiotics.Methods: review of literature from allergic reaction and toxicity, specific reaction, double infection, drug combination cause or aggravate adverse reactions and other aspects, summarizes the antibiotic adverse drug reactions and clinical harm.Results the adverse reactions of antibiotics can be prevented and controlled, and the clinical monitoring should be paid attention to during the proce of taking drugs.Conclusion the adverse drug reactions of antibiotics should be paid more attention to by clinicians.Key words] antibiotics;adverse reactions
Adverse drug reactions are common in clinical medication.It refers not only to the side effects of drugs, but also to the toxicity, specific reactions, allergic reactions, secondary reactions, etc.[1].Antimicrobial agents are the most commonly used drugs in clinic, including antibiotics, anti fungi, anti tuberculosis and antibacterial agents.Among them, there are the most varieties and quantities of antibiotics used in clinic.At present, there are more than 100 kinds of antibiotics commonly used in clinic.Antibiotics have saved countle lives, but their clinical use has also caused some adverse reactions [2].The adverse clinical consequences of antibiotic adverse drug reactions are severe.After a few seconds to a few hours or even a long period of time after the drug withdrawal, adverse reactions can occur.Common allergic shock, fixed drug eruption, urticaria, vascular edema and other allergic reactions, gastrointestinal reactions, aplastic anemia, etc., and even cause death of patients(3).Therefore, to strengthen the supervision and rational use of antibiotics in the course of clinical medication is of great significance to reduce the incidence of adverse reactions [4].allergic reactions
Antibiotic induced allergic reactions are most common [5], mainly due to poible impurities in the drug, as well as the effects of oxidation, decomposition, polymerization, degradation products in vivo, or individual differences in the patient.Allergic reactions occur in many patients with allergic diseases, and a few are specific Gao Min constitutions.1.1 anaphylactic shock, this type of reaction is type I allergy, all routes of administration can cause.For example, penicillins, aminoglycosides and cephalosporins can cause such reactions, and cro allergic reactions can also occur between cephalosporins and penicillins.Therefore, the skin test must be done before using this drug.1.2 hemolytic anemia belongs to type II allergy, which is manifested by various kinds of blood cell reduction.Such as: thiophene thiophene and chloramphenicol can cause thrombocytopenia, penicillin and cephalosporins can cause hemolytic anemia.1.3 serum drug fever disease, belongs to the type III allergy symptoms, for seventh to 14 days of urticaria, angioedema, joint pain and joint peripheral edema and fever, gastrointestinal ulcer and intestinal necrosis.For example, penicillins, cephalosporins, lincomycin and streptomycin can all cause the above reactions.Cephalosporins, chloramphenicol and other antibacterial drugs can also cause drug fever.1.4 allergic reactions, this is a type of allergic reactions belonging to type IV allergy.Frequent exposure to streptomycin or penicillin usually occurs within 3~12 months.No allergic reaction in 1.5 types of rash(urticaria is common)6, angioedema, dermatitis, erythroderma, erythema multiforme, fixed exudative erythema, severe bullous erythema, toxic epidermal necrolysis, found in penicillins, cephalosporins, streptomycin four ring and lincomycin;visceral lesions, including acute and chronic interstitial pneumonia, bronchial asthma, allergic hepatitis, diffuse allergic nephritis, penicillin, streptomycin and in common.Compound sulfamethoxazole can also cause severe exfoliative dermatitis.toxicity
The toxic reaction of antibiotic drugs is the direct damage to the organs and tiues of human body caused by drugs, which leads to the pathological changes of the physiological and biochemical functions of the body，Usually aociated with dosage and duration.2.1, the toxicity of the nervous system, such as penicillin, G, ampicillin and so on, can cause central nervous system toxicity, severe cases may occur epileptic seizures.Penicillin and tetracycline can cause mental disorders.Aminoglycoside, vancomycin, polymyxin, and tetracycline can cause toxicity to the ear and vestibular nerve.Streptomycin, multi-viscosity, chloramphenicol, rifampicin and erythromycin can cause eye accommodation, dysfunction, optic neuritis and even optic atrophy.Clarithromycin, a new macrolide drug, can cause psychiatric adverse reactions.In addition, macrolides, clarithromycin and azithromycin may reduce presynaptic acetylcholine release or enhance postsynaptic receptor inhibition, which can lead to myasthenia crisis.2.2 renal toxicity.Many antibiotics can cause kidney damage, such as aminoglycosides, polymyxin, vancomycin.The most important side effect of aminoglycosides is ear kidney toxicity.In the patients with renal insufficiency, the half-life of the third generation cephalosporin has been extended to varying degrees, which should be paid more attention to by clinicians.2.3 liver toxicity 7: amphotericin B and lincomycin can cause toxic hepatitis, large dose of tetracycline can cause severe hepatitis caused by invasive, macrolides and oxacillin cholestatic hepatitis, cephalosporins in cephalothin and cefaloridine and penicillin in oxacillin, carbenicillin I ampicillin resistant, can cause elevated transaminase, streptomycin, tetracycline and amphotericin B can cause liver cell jaundice.2.4 of the blood system toxicity such as chloramphenicol can cause aplastic anemia and poisoning of agranulocytosis, a large dose of penicillin may occasionally result in abnormal blood coagulation, third generation cephalosporins such as cefotaxime and moxalactam due to intestinal flora of normal synthesis of vitamin K can cause bleeding reaction.2.5 the toxicity of the immune system, such as amphotericin B, cefoxitin, chloramphenicol, clindamycin and tetracycline [6].It has toxic effects on the immune system and mechanism.2.6 gastrointestinal toxicity, gastrointestinal adverse reactions are more common.Drugs that can cause gastrointestinal reactions, such as oral tetracycline, penicillins, etc., including macrolides, chloramphenicol and other drugs, even if injected, can also cause gastrointestinal reactions.2.7 cardiac toxicity, large doses of penicillin, chloramphenicol and streptomycin can cause cardiotoxicity, and amphotericin B can cause myocardial damage, and lincomycin can occasionally lead to arrhythmias.specific reaction
The specific response is a very different reaction to the drug action in a small number of patients.The reaction is related to the lack of a genetic enzyme system in the patient.Chloramphenicol and amphotericin B enters the body, can enter the red cells with red cell membrane, hemoglobin into denatured hemoglobin, the enzyme system for normal persons, use of these drugs had no effect;but for hereditary methemoglobinemia, enhance the body's sensitivity to the drug, even if the use of small doses of drugs, but also can lead to degeneration of hemoglobin.double infection
Under normal circumstances, there are many bacterial and fungal parasites on the surface of human body and lumen mucosa.Because of their existence, the microbial ecosystem of the body is kept in balance with each other.When high doses or long-term use of antibiotics, parasitic sensitive bacteria are killed, not sensitive strain and resistant bacteria proliferation become dominant, alien bacteria could get inside, when this kind of bacteria pathogens, can cause the double infection.The common clinical symptoms of double infection are digestive tract infection, enteritis, pneumonia, urinary tract infection and septicemia.antibiotics can cause or aggravate adverse reactions when used in combination with other drugs [8]
In the proce of clinical treatment, most cases need combination therapy, such as chronic diseases(diabetes and cancer)infection, surgical prophylaxis, severe infection, with organ symptoms, need to symptomatic treatment.Because of the interaction of drugs, it may cause or aggravate the adverse reactions of antibiotics.5.1, in combination with cardiovascular drugs, erythromycin and tetracycline can inhibit the metabolism of digoxin.When used in combination, it can lead to a marked increase in serum concentration and digoxin intoxication.5.2, combined with anticoagulant drugs, cephalosporins and chloramphenicol can inhibit the metabolism of coumarin anticoagulant in the liver, which can prolong the half-life of the latter, increase the effect and prolong the clotting time.Erythromycin can increase the effect of Hua Falin and prolong the clotting time.Tetracycline can affect the synthesis of vitamin K in intestinal flora, thus enhancing the effect of anticoagulant.5.3、in combination with theophylline drugs, macrolides can inhibit the cytochrome P450 enzyme system and increase the serum concentration of theophylline.When the combination of erythromycin and theophylline, theophylline serum concentration can increase by about 40%, while theophylline can affect the absorption of erythromycin and reduce the peak concentration of erythromycin.5.4, in combination with hypoglycemic agents, the use of chloramphenicol, toluene, sulfonylurea, and sulfonylurea can inhibit the metabolism of the latter, prolong its half-life, increase serum concentration, and increase its effect, which can lead to acute hypoglycemia.5.5 combined with diuretics aminoglycoside gentamicin and furan aniline in combination with acids, caused by the increase in reported ototoxicity.The use of ceftazidime in combination with furosemide increases nephrotoxicity, probably because the rate of clearance is lower in combination.Cyclosporine and mannitol, can cause severe kidney necrotic changes after discontinuation of mannitol renal allograft function, can be recovered.5.6, in combination with other drugs, erythromycin, tetracycline and antacids can reduce the absorption of antibiotics.Macrolide erythromycin and C Masi Bing can cause poisoning symptoms when combined with C Masi Bing.To sum up, the rational use of antibiotics and clinical monitoring in the proce of patient medication are of great significance for clinicians to safely use drugs, to ensure the health of patients and to reduce the incidence of adverse reactions.The correct diagnosis is to distinguish whether it is a bacterial infection, such as using the culture of the specimen to judge that it is a bacterial infection, which is the indication of the application of antibiotics.Familiar with the pharmacological effects of antibiotics and adverse reaction characteristics, clinical pharmacology, drug control antimicrobial spectrum, indications, contraindications, adverse reactions and preparation, dosage, ways and methods, to understand patients drug allergy history, the use of drugs targeted to avoid the occurrence of the adverse reactions.Strengthening ADR monitoring [9~11] in the three aspects of medicine, nursing and medicine.Drug monitoring, clinical blood and biochemical tests, monitoring, nursing care and so on [12].Especially the monitoring of serum concentration of aminoglycosides and renal function should be monitored and listening;monitoring of blood concentration affected by drug combination, such as erythromycin or tetracycline and digoxin, monitoring or avoid the combination of digoxin concentration;oral anticoagulants and chloramphenicol, tetracycline, erythromycin when combined, patients should be monitored for the coagulation time, or avoid the combination;must be combined to adjust the dose of oral anticoagulants.Nursing staff have more contact with patients, careful and meticulous nursing work, especially for children and elderly patients, is an important link to discover and deal with adverse drug reactions in time.To train nurses in clinical pharmacology knowledge and increase their knowledge in order to find out problems and report and deal with them in time.Once adverse reactions are detected, drastic steps, such as withdrawal or change of dreings, should be taken.If an allergic reaction occurs, immediate rescue measures should be taken.These practices are effective in preventing and remedying the adverse effects of antibiotics.[References] Zhang Keyi, Zhao Naicai.Grand ceremony for clinical adverse drug reactions.Shenyang: Liaoning science and Technology Pre, 2001, 96.2 Yang Liping.Talk about the rational use of antimicrobial drugs.The theory and practice of medicine, 2004,17(2): 229.Wang Zhengchun, Li Qiu, Wang Shan.Analysis of 803 cases of adverse drug reactions.Journal of medicine, 2004,23(9): 695-696.tickets, Wang Xiumei
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