摘要
目的探讨老年人(≥60岁)使用抗菌药物致凝血功能异常/血小板(PLT)减少严重不良反应(ADR)发生的规律和特点,为临床安全用药提供参考。方法检索2017年1月-2022年4月中国知网、万方数据库、维普中文数据库、Embase、PubMed、Web of Science中抗菌药物致凝血功能异常/PLT减少严重ADR相关的病例报道类文献,提取患者相关信息(国籍、性别、年龄、体重、抗菌药物应用情况、合并疾病、合并用药情况及不良反应(ADR)的发生、处置及转归等)进行描述性统计分析。结果共收集到老年患者凝血功能异常/PLT减少严重ADR相关报告类文献49篇,病例56例,其中男性32例(57.14%),女性24例(42.86%);中位年龄78岁(60~93岁);由于存在联合使用抗菌药物,涉及的抗菌药物总例次为58例次,排名前3位的抗菌药物种类及例次数分别为头孢菌素类15例次(25.86%)、噁唑烷酮类13例次(22.41%)和甘氨酰环素类11例次(18.97%)。36例(64.29%)仅为PLT减少,18例(32.14%)仅为凝血功能异常,2例(3.57%)同时出现PLT减少和凝血功能异常。2例(3.57%)用药当天出现ADR;37例(66.07%)于1~7 d出现;16例(28.57%)于8~15 d出现;1例(1.78%)于30 d以上出现。结论抗菌药物引起老年患者凝血功能异常/PLT减少严重ADR并不少见,其中以头孢菌素类、噁唑烷酮类及甘氨酰环素类药物多见,在使用这些抗菌药物时,特别当患者合并多个出血危险因素时,应仔细询问病史,注意定期监测血常规。
Objective To investigate the general rules and characteristics of severe adverse drug reactions(ADR)manifested as coagulopathy/thrombocytopenia caused by antibiotics in the elderly(≥60 years old),and provide reference for safe clinical drug use.Methods Databases of CNKI,Wangfang Database,VIP Database,Embase,PubMed and Web of Science were searched with searching time from January 2017 to April 2022,and case reports related to severe ADR manifested as coagulopathy/thrombocytopenia caused by antibiotics in the elderly were collected.Relevant information of patients(nationality,gender,age,weight,application of antibiotics,co-existing diseases and combined drugs,the occurrence,treatment and outcome of ADR,etc.)was extracted and analyzed descriptively.Results A total of 49 literature reports related to severe ADR manifested as coagulopathy/thrombocytopenia caused by antibiotics in the elderly were included,involving 56 patients.There were 32 males(57.14%)and 24 females(42.86%),with a median age of 78 years old(60~93).Due to the combined use of antibiotics,58 cases of antibiotics were involved.The top three categories of antibiotics involved were cephalosporins(15 cases,25.86%),oxazolidinones(13 cases,22.41%)and glycylcycline(11 cases,18.97%).Thirty-six cases(64.29%)showed thrombocytopenia,18 cases(32.14%)showed coagulopathy,and 2 cases(3.57%)showed both symptoms.ADR in 2 cases(3.57%)occurred on the day of administration;ADR in 38 cases(66.07%)occurred 1 to 7 days after administration;ADR in 16 cases(28.57%)occurred 8 to 15 days after administration;ADR in 1 case(1.78%)occurred more than 30 days after administration.Conclusion Severe ADR of coagulopathy/thrombocytopenia caused by antibiotics in the elderly is not rare.Most of them are caused by cephalosporins,oxazolidinones and glycylcyclines.In the use of these antibiotics,especially when patients had multiple risk factors for bleeding,the medical history should be inquired carefully and the blood routine should be monitored regularly.
作者
周柳君
李晓玲
张青霞
Zhou Liujun;Li Xiaoling;Zhang Qingxia(Department of Pharmacy,Xuanwu Hospital of Capital Medical University,National Gerontic Disease Clinical Research Center,Beijing 100053,China;Department of Clinical Pharmacy,School of Pharmacy,Capital Medical University,Beijing 100069,China)
出处
《实用药物与临床》
CAS
2023年第3期241-246,共6页
Practical Pharmacy and Clinical Remedies
基金
国家重点研发计划资助(2020YFC2008300)。
