抗生素的不良反应Adverse reactions of antibioticsWord格式.docx
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reviewofliteraturefromallergicreactionandtoxicity,specificreaction,doubleinfection,drugcombinationcauseoraggravateadversereactionsandotheraspects,summarizestheantibioticadversedrugreactionsandclinicalharm.Resultstheadversereactionsofantibioticscanbepreventedandcontrolled,andtheclinicalmonitoringshouldbepaidattentiontoduringtheprocessoftakingdrugs.Conclusiontheadversedrugreactionsofantibioticsshouldbepaidmoreattentiontobyclinicians.
Keywords]antibiotics;
adversereactions
Adversedrugreactionsarecommoninclinicalmedication.Itrefersnotonlytothesideeffectsofdrugs,butalsotothetoxicity,specificreactions,allergicreactions,secondaryreactions,etc.[1].Antimicrobialagentsarethemostcommonlyuseddrugsinclinic,includingantibiotics,antifungi,antituberculosisandantibacterialagents.Amongthem,therearethemostvarietiesandquantitiesofantibioticsusedinclinic.Atpresent,therearemorethan100kindsofantibioticscommonlyusedinclinic.Antibioticshavesavedcountlesslives,buttheirclinicalusehasalsocausedsomeadversereactions[2].Theadverseclinicalconsequencesofantibioticadversedrugreactionsaresevere.Afterafewsecondstoafewhoursorevenalongperiodoftimeafterthedrugwithdrawal,adversereactionscanoccur.Commonallergicshock,fixeddrugeruption,urticaria,vascularedemaandotherallergicreactions,gastrointestinalreactions,aplasticanemia,etc.,andevencausedeathofpatients(3).Therefore,tostrengthenthesupervisionandrationaluseofantibioticsinthecourseofclinicalmedicationisofgreatsignificancetoreducetheincidenceofadversereactions[4].
1allergicreactions
Antibioticinducedallergicreactionsaremostcommon[5],mainlyduetopossibleimpuritiesinthedrug,aswellastheeffectsofoxidation,decomposition,polymerization,degradationproductsinvivo,orindividualdifferencesinthepatient.Allergicreactionsoccurinmanypatientswithallergicdiseases,andafewarespecificGaoMinconstitutions.
1.1anaphylacticshock,thistypeofreactionistypeIallergy,allroutesofadministrationcancause.Forexample,penicillins,aminoglycosidesandcephalosporinscancausesuchreactions,andcrossallergicreactionscanalsooccurbetweencephalosporinsandpenicillins.Therefore,theskintestmustbedonebeforeusingthisdrug.
1.2hemolyticanemiabelongstotypeIIallergy,whichismanifestedbyvariouskindsofbloodcellreduction.Suchas:
thiophenethiopheneandchloramphenicolcancausethrombocytopenia,penicillinandcephalosporinscancausehemolyticanemia.
1.3serumdrugfeverdisease,belongstothetypeIIIallergysymptoms,forseventhto14daysofurticaria,angioedema,jointpainandjointperipheraledemaandfever,gastrointestinalulcerandintestinalnecrosis.Forexample,penicillins,cephalosporins,lincomycinandstreptomycincanallcausetheabovereactions.Cephalosporins,chloramphenicolandotherantibacterialdrugscanalsocausedrugfever.
1.4allergicreactions,thisisatypeofallergicreactionsbelongingtotypeIVallergy.Frequentexposuretostreptomycinorpenicillinusuallyoccurswithin3~12months.
Noallergicreactionin1.5typesofrash(urticariaiscommon)6,angioedema,dermatitis,erythroderma,erythemamultiforme,fixedexudativeerythema,severebullouserythema,toxicepidermalnecrolysis,foundinpenicillins,cephalosporins,streptomycinfourringandlincomycin;
viscerallesions,includingacuteandchronicinterstitialpneumonia,bronchialasthma,allergichepatitis,diffuseallergicnephritis,penicillin,streptomycinandincommon.Compoundsulfamethoxazolecanalsocausesevereexfoliativedermatitis.
2toxicity
Thetoxicreactionofantibioticdrugsisthedirectdamagetotheorgansandtissuesofhumanbodycausedbydrugs,whichleadstothepathologicalchangesofthephysiologicalandbiochemicalfunctionsofthebody,
Usuallyassociatedwithdosageandduration.
2.1,thetoxicityofthenervoussystem,suchaspenicillin,G,ampicillinandsoon,cancausecentralnervoussystemtoxicity,severecasesmayoccurepilepticseizures.Penicillinandtetracyclinecancausementaldisorders.Aminoglycoside,vancomycin,polymyxin,andtetracyclinecancausetoxicitytotheearandvestibularnerve.Streptomycin,multi-viscosity,chloramphenicol,rifampicinanderythromycincancauseeyeaccommodation,dysfunction,opticneuritisandevenopticatrophy.
Clarithromycin,anewmacrolidedrug,cancausepsychiatricadversereactions.Inaddition,macrolides,clarithromycinandazithromycinmayreducepresynapticacetylcholinereleaseorenhancepostsynapticreceptorinhibition,whichcanleadtomyastheniacrisis.
2.2renaltoxicity.Manyantibioticscancausekidneydamage,suchasaminoglycosides,polymyxin,vancomycin.Themostimportantsideeffectofaminoglycosidesisearkidneytoxicity.Inthepatientswithrenalinsufficiency,thehalf-lifeofthethirdgenerationcephalosporinhasbeenextendedtovaryingdegrees,whichshouldbepaidmoreattentiontobyclinicians.
2.3livertoxicity7:
amphotericinBandlincomycincancausetoxichepatitis,largedoseoftetracyclinecancauseseverehepatitiscausedbyinvasive,macrolidesandoxacillincholestatichepatitis,cephalosporinsincephalothinandcefaloridineandpenicillininoxacillin,carbenicillinIampicillinresistant,cancauseelevatedtransaminase,streptomycin,tetracyclineandamphotericinBcancauselivercelljaundice.
2.4ofthebloodsystemtoxicitysuchaschloramphenicolcancauseaplasticanemiaandpoisoningofagranulocytosis,alargedoseofpenicillinmayoccasionallyresultinabnormalbloodcoagulation,thirdgenerationcephalosporinssuchascefotaximeandmoxalactamduetointestinalfloraofnormalsynthesisofvitaminKcancausebleedingreaction.
2.5thetoxicityoftheimmunesystem,suchasamphotericinB,cefoxitin,chloramphenicol,clindamycinandtetracycline[6].Ithastoxiceffectsontheimmunesystemandmechanism.
2.6gastrointestinaltoxicity,gastrointestinaladversereactionsaremorecommon.Drugsthatcancausegastrointestinalreactions,suchasoraltetracycline,penicillins,etc.,includingmacrolides,chloramphenicolandotherdrugs,evenifinjected,canalsocausegastrointestinalreactions.
2.7cardiactoxicity,largedosesofpenicillin,chloramphenicolandstreptomycincancausecardiotoxicity,andamphotericinBcancausemyocardialdamage,andlincomycincanoccasionallyleadtoarrhythmias.
3specificreaction
Thespecificresponseisaverydifferentreactiontothedrugactioninasmallnumberofpatients.Thereactionisrelatedtothelackofageneticenzymesysteminthepatient.ChloramphenicolandamphotericinBentersthebody,canentertheredcellswithredcellmembrane,hemoglobinintodenaturedhemoglobin,theenzymesystemfornormalpersons,useofthesedrugshadnoeffect;
butforhereditarymethemoglobinemia,enhancethebody'
ssensitivitytothedrug,eveniftheuseofsmalldosesofdrugs,butalsocanleadtodegenerationofhemoglobin.
4doubleinfection
Undernormalcircumstances,therearemanybacterialandfungalparasitesonthesurfaceofhumanbodyandlumenmucosa.Becauseoftheirexistence,themicrobialecosystemofthebodyiskeptinbalancewitheachother.Whenhighdosesorlong-termuseofantibiotics,parasiticsensitivebacteriaarekilled,notsensitivestrainandresistantbacteriaproliferationbecomedominant,alienbacteriacouldgetinside,whenthiskindofbacteriapathogens,cancausethedoubleinfection.Thecommonclinicalsymptomsofdoubleinfectionaredigestivetractinfection,enteritis,pneumonia,urinarytractinfectionandsepticemia.
5antibioticscancauseoraggravateadversereactionswhenusedincombinationwithotherdrugs[8]
Intheprocessofclinicaltreatment,mostcasesneedcombinationtherapy,suchaschronicdiseases(diabetesandcancer)infection,surgicalprophylaxis,severeinfection,withorgansymptoms,needtosymptomatictreatment.
Becauseoftheinteractionofdrugs,itmaycauseoraggravatetheadversereactionsofantibiotics.
5.1,incombinationwithcardiovasculardrugs,erythromycinandtetracyclinecaninhibitthemetabolismofdigoxin.Whenusedincombination,itcanleadtoamarkedincreaseinserumconcentrationanddigoxinintoxication.
5.2,combinedwithanticoagulantdrugs,cephalosporinsandchloramphenicolcaninhibitthemetabolismofcoumarinanticoagulantintheliver,whichcanprolongthehalf-lifeofthelatter,increasetheeffectandprolongtheclottingtime.ErythromycincanincreasetheeffectofHuaFalinandprolongtheclottingtime.TetracyclinecanaffectthesynthesisofvitaminKinintestinalflora,thusenhancingtheeffectofanticoagulant.
5.3、incombinationwiththeophyllinedrugs,macrolidescaninhibitthecytochromeP450enzymesystemandincreasetheserumconcentrationoftheophylline.Whenthecombinationoferythromycinandtheophylline,theophyllineserumconcentrationcanincreasebyabout40%,whiletheophyllinecanaffecttheabsorptionoferythromycinandreducethepeakconcentrationoferythromycin.
5.4,incombinationwithhypoglycemicagents,theuseofchloramphenicol,toluene,sulfonylurea,andsulfonylureacaninhibitthemetabolismofthelatter,prolongitshalf-life,increaseserumconcentration,andin