抗生素的不良反应Adverse reactions of antibiotics.docx

抗生素的不良反应Adverse reactions of antibiotics.docx

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抗生素的不良反应Adversereactionsofantibiotics

抗生素的不良反应（Adversereactionsofantibiotics）

Adversereactionsofantibiotics

[Abstract]objectivetohelpcliniciansunderstandtheadversedrugreactionsofantibioticsandpromoterationaluseofantibioticsinclinic,soastoensurethesafety,effectivenessandrationalityoftheuseofantibiotics.Methods:

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