Anaphylactoid reaction considered ciprofloxacin related: a case report and literature review.
Anaphylactoid reaction considered ciprofloxacin related: a case report and literature review.
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DOI：
10.1016/j.clinthera.2010.03.002
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发表时间：
2010-03
影响因子：
3.2
通讯作者：
Tsiodras S
中科院分区：
文献类型：
--
作者：
Kelesidis T;Fleisher J;Tsiodras S
虽然环丙沙星是一种普遍耐受良好的氟喹诺酮类抗生素，但使用环丙沙星时有严重和危及生命的不良事件，如过敏反应和肺水肿。然而，在科学文献中缺乏关于这些事件的数据。本报告描述一例类过敏反应，可能与环丙沙星有关，表现为血管性水肿，后来为肺水肿。本报告还总结了有关环丙沙星相关类过敏反应的流行病学、发病机制和结局的现有科学证据。先前报告的病例是通过MEDLINE和EMBASE检索确定的（年份：1960 - 2009年6月；英文文章；检索词：环丙沙星、类过敏反应、过敏反应、血管性水肿和肺水肿）。审查了这些文章中引用的参考文献，以确定其他报告。25岁健康白人女性，体重65公斤，肾功能正常，肾盂肾炎。根据需要给予环丙沙星500mg BID PO和布洛芬400mg q6h PO以控制疼痛。第二天出现血管性水肿和肺水肿，认为可能与使用环丙沙星有关（Naranjo药物不良反应概率量表评分，6）。停用环丙沙星治疗，给予头孢曲松1 g/d IV支持治疗，患者住院1周后康复。与氟喹诺酮类药物摄入相关的药物不良反应最常影响胃肠道系统、中枢神经系统和皮肤。文献检索发现64例类过敏反应，认为可能与环丙沙星有关。其中42例在大型研究中被描述，但没有详细的数据报道。病例报告中描述的22例病例提供了环丙沙星剂量、环丙沙星给药到类过敏反应之间的时间、临床表现和这些反应的结果的详细信息。这些病例中有12例是艾滋病患者；10例HIV阳性患者。除2例感染艾滋病毒的患者死亡（1例死亡原因不明，另1例死于弓形虫脑炎）外，所有患者均康复。14名患者（包括所有感染艾滋病毒的患者）需要在重症监护室住院。根据环丙沙星制造商的说法，肺水肿在<1%的治疗患者中被描述为环丙沙星相关的不良事件。然而，MEDLINE和EMBASE数据库的检索没有发现任何环丙沙星相关肺水肿的文献报告。在本病例报告中描述的患者经历了可能与使用环丙沙星相关的类过敏反应。虽然与环丙沙星和其他氟喹诺酮类药物相关的类过敏反应并不常见（<5%的病例），但临床医生应该意识到这一潜在的危及生命的事件，即使在肾功能正常的情况下，它也可能导致肺水肿。
Although ciprofloxacin is a generally well-tolerated fluoroquinolone antibiotic, serious and life-threatening adverse events such as anaphylaxis and pulmonary edema have been described with its use. However, there is a lack of data in the scientific literature regarding these events. This report describes a case of an anaphylactoid reaction, considered probably ciprofloxacin related, that manifested as angioedema and later as pulmonary edema. This report also summarizes the available scientific evidence regarding the epidemiology, pathogenesis, and outcome of ciprofloxacin-associated anaphylactoid reactions. Previously reported cases were identified using a search of MEDLINE and EMBASE (years: 1960–June 2009; English-language articles; search terms: ciprofloxacin, anaphylactoid reaction, anaphylaxis, angioedema, and pulmonary edema). The references cited in these articles were examined to identify additional reports. A 25-year-old healthy white woman with a weight of 65 kg and normal renal function presented with pyelonephritis. She was administered ciprofloxacin 500 mg BID PO and ibuprofen 400 mg q6h PO as needed for pain control. The following day, angioedema and pulmonary edema developed and were thought to be probably associated with ciprofloxacin use (Naranjo adverse drug reaction probability scale score, 6). Ciprofloxacin treatment was discontinued and supportive care with ceftriaxone 1 g/d IV was provided, and the patient recovered after 1 week of hospitalization. The adverse drug reactions associated with the intake of fluoroquinolones most commonly affect the gastrointestinal system, central nervous system, and skin. The literature search identified 64 cases of anaphylactoid reaction considered probably ciprofloxacin related. Forty-two of these cases were described in large studies, with no detailed data reported. Detailed information on the dose of ciprofloxacin, the time period between ciprofloxacin administration and anaphylactoid reaction, clinical manifestations, and outcomes of these reactions was available in 22 cases described in case reports. Twelve of these cases were described in HIV– patients; 10 cases were described in HIV+ patients. All of the patients recovered, with the exception of 2 patients with HIV infection, who died (unknown cause of death in 1 case and toxoplasma encephalitis in the other case). Fourteen patients (including all of the patients with HIV infection) required hospitalization in the intensive care unit. According to the manufacturer of ciprofloxacin, pulmonary edema has been described as an adverse event associated with ciprofloxacin in <1% of treated patients. However, a search of the MEDLINE and EMBASE databases did not identify any documented reports of ciprofloxacin-associated pulmonary edema. The patient described in this case report experienced an anaphylactoid reaction likely associated with ciprofloxacin use. Although anaphylactoid/anaphylactic reactions are uncommon (<5% of cases) adverse events associated with ciprofloxacin and other fluoroquinolones, clinicians should be aware of this potentially life-threatening event, which might also lead to pulmonary edema even in the setting of normal renal function.
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