Unexpectedly, these antibacterial drugs can cause drug-induced diseases

*Only for medical professionals to read and refer to those things about antibacterial drugs, you must know! Antibacterial drugs are commonly used clinically, which can not only reduce the incidence of patient infections, but also reduce the mortality of patients.

However, in recent years, the abuse of antibacterial drugs has been very serious.
In addition to causing drug resistance, it may also induce a variety of drug-induced diseases.

Diseases such as anaphylactic shock, hematuria, red man syndrome, and pseudomembranous enteritis may be caused by antibiotics.

In the last issue, Jie Xiaoyao shared with you 3 cases of drug-induced diseases (see 3 classic cases for details on adverse reactions caused by antibacterial drugs!), which aroused the attention of clinicians and pharmacists to drug-induced diseases.

Today, we will continue to analyze common drug-induced diseases through 3 cases of antibacterial drugs for clinical reference.

Case 1: Red Man Syndrome Basic information patient, male, premature baby, 2 months old, admitted to the hospital for 1 week due to cough.

Admission diagnosis (1) severe pneumonia; (2) bronchopulmonary dysplasia.

Related drugs: Vancomycin Hydrochloride 60mg+5% Glucose Injection 15ml, intravenous drip at a rate of 60mg/h.

About 10 minutes after the infusion of the drug solution, the child cried and the face flushed; adjusted the infusion rate to 40mg/h, the child still cried, skin erythema increased, and large patches of erythema appeared on the neck, chest and limbs.
, The heart rate is increased to 160 beats/min.

Consider red man syndrome (RMS) caused by vancomycin allergy.

Discussion The mechanism of vancomycin-related RMS is histamine-mediated hypersensitivity, involving mast cells and basophils, and the release of histamine is related to the rate of infusion.

The rapid infusion of vancomycin causes an increase in histamine levels in the body, which mediates hypersensitivity reactions and RMS.

However, some studies have reported that the dosage and infusion speed are in line with the recommendations of the drug inserts, which can also cause RMS.

The child in this case is a premature baby with short length and low weight, which may be related to the occurrence of RMS.

The pharmacokinetics of vancomycin in neonates and premature infants are significantly different from those in children and adults.

Vancomycin's half-life (t1/2), volume of distribution, peak value, and clearance rate vary significantly among newborns (especially premature infants).

Therefore, it is speculated that the speed of intravenous infusion of vancomycin in neonates and premature infants cannot completely follow the recommendations of adults and other children.

It is recommended that the initial rate of intravenous infusion of vancomycin in neonates and premature infants should be lower than the recommended rate, and if there are no adverse reactions, then gradually increase to the recommended rate to ensure the safety of neonates and premature infants.

Case 2: Neurotoxicity Basic information: A female, 84-year-old patient, was admitted to the hospital for "indwelling a catheter for 1 month and turbid urine for more than 7 days".

Admission diagnosis (1) urinary tract infection; (2) after indwelling catheter; (3) essential hypertension, hypertension, nephropathy, chronic renal failure (CKD stage 5); (4) lung infection; (5) bronchiectasis ; (6) Reflux Esophagitis; (7) Gouty Arthritis; (8) Urinary Retention.

Related drug imipenem and cilastatin injection powder injection 1g q12h ivd.

Three days after the occurrence, vomiting, intermittent twitching of the face and limbs suddenly appeared in the early morning of the process, and the left lower limb was suspected of positive Pap sign, and the adverse reaction was suspected to be caused by the imipenem/cilastatin injection powder injection.

Discussion The clinically induced epilepsy antibacterial drugs are mostly fluoroquinolones and carbapenems (mainly imipenem/cilastatin).

The incidence of neurotoxicity of carbapenem antibiotics is about 0.
01%-3%, among which: the incidence of high-dose imipenem (1.
0g/6h or >2g/d) is about 3%; imipenem The incidence of statin is about 1.
5%, which is nearly 10 times higher than penicillin; panipenem, meropenem, faropenem, ertapenem and donipenem have lower neurotoxicity.

The main risk factors for neurotoxicity caused by carbapenem antibiotics are: decreased renal function, basic diseases of the central nervous system (such as stroke, head trauma, etc.
), age <7 months or> 60 years, low body weight, meningitis Or endocarditis, intracerebroventricular or intraventricular drug dosage, etc.

The epilepsy induced by imipenem/cilastatin sodium in this case was probably due to advanced age, renal insufficiency, and excessive drug dose.

Once epileptic seizures occur, stop the medication immediately or switch to drugs with less central adverse reactions, and use symptomatic treatments such as diazepam, sodium valproate, and phenobarbital.
If the symptoms are difficult to control, hemodialysis may be considered to remove the body.
drug.

Case 3: Pseudomembranous enteritis.
Basic information patient, female, 77 years old, was admitted to the hospital because of "upper abdominal distension and pain for more than 1 month, worsening and diarrhea for 4 days".

Admitted to the hospital to diagnose pseudomembranous enteritis.

Related drugs were treated with cefoperazone and sulbactam + furazolidone tablets for 1 week before admission.

During the process, the patient developed yellow pus-like stool.

Stool routinely showed yellow pus-like stool, white blood cells +++, red blood cells + +, occult blood was positive, and macrophages were 0-2.

Endoscopy: Early manifestation of mucosal congestion and edema.
As the disease progresses, patchy pseudomembranes and dotted pseudomembranes can be seen, ranging from 2-30mm, grayish yellow or yellowish white, slightly higher than the mucosa, and there may be flushing around , Jumping scattered distribution, congestion and edema of the inter-pseudomembrane mucosa, the pseudomembrane is not easy to peel off, forcible peeling can show erosion and blood oozing.

Pathological examination of biopsy showed mucosal epithelial cell necrosis, inflammatory bacterial infiltration, congestion of the membrane propria, and swelling and effusion of glandular cavity.

Clostridium difficile can be isolated by inoculating pseudo-membrane in selective medium.

Discussion Pseudomembranous enteritis is more likely to occur with broad-spectrum antibacterial drugs.
Elderly patients and people with weaker physique are the high-risk population of such diseases.

If older patients develop diarrhea after using broad-spectrum antibacterial drugs, sufficient attention should be paid to consider the possibility of pseudomembranous enteritis, diagnosis should be made through a variety of methods, and timely and effective treatment should be given to prevent affecting the life safety of patients.
.

Summarizing the above cases, we can see that most drug-induced diseases can be avoided in the correct and reasonable application of antibacterial drugs.
Therefore, we should strictly grasp the medication indications, control the dosage of medication, and pay attention to the medication of special populations.

When encountering drug-induced diseases, they can be prepared to make judgments and take timely treatment to minimize the risk.

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The effect of carbapenem antibiotics Neurotoxicity[J].
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[4]Shi Lei,Wang Qizhi,Xi Junli.
A case report of antibiotic-related pseudomembranous enteritis and literature review[J].
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Clinical diagnosis and treatment of antibiotic-associated enteritis[J].
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