Lalkin A, Kapur B M, Verjee Z H, Koren G
Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, Ontario, Canada.
Ann Pharmacother. 1999 Mar;33(3):314-7. doi: 10.1345/aph.18132.
To report an accidental contamination of antibiotic suspension by methadone that occurred in a retail Canadian pharmacy, leading to severe poisoning in a young child.
A 4 1/2-year-old healthy Asian boy was prescribed amoxicillin suspension for cough and fever. Shortly after receiving the second dose of 5 mL he became drowsy and less responsive. On admission, he was arousable by deep pain, and pinpoint pupils were noted. A urine sample sent for a toxicology screen revealed the presence of methadone and its metabolite. Blood methadone concentrations were 0.23 and 0.14 mg/L, five and nine hours after the second dose of amoxicillin was given, respectively. The amoxicillin suspension was tested for methadone and was found to have a concentration of 2.4 g/L. The child gradually improved and was discharged on day 4 in good condition. The pharmacy in which the antibiotic was dispensed has been a dispensing center for a local methadone maintenance program, and methadone was accidentally mixed with the antibiotics.
In this case, a near fatal outcome occurred when methadone was inadvertently mixed with antibiotics in a community pharmacy. A literature search revealed two previous reports of opiate toxicity in children following ingestion of oral antibiotic preparations.
Prompt action is needed in Canadian pharmacies that dispense methadone in order to minimize such errors in the future. General practitioners, pediatricians, and emergency department physicians should recognize and suspect this rare cause of opiate toxicity in a child. In a patient presenting with a decreased level of consciousness and miosis, with or without respiratory depression, naloxone administration should be considered, whether or not a history of opioid ingestion is obtained.
报告加拿大一家零售药店发生的美沙酮意外污染抗生素混悬液事件，该事件导致一名幼儿严重中毒。
一名4岁半健康的亚洲男孩因咳嗽和发烧被开了阿莫西林混悬液。在服用第二剂5毫升后不久，他变得嗜睡且反应迟钝。入院时，他对深部疼痛有反应，瞳孔针尖样。送检的一份尿液毒理学筛查样本显示含有美沙酮及其代谢物。在服用第二剂阿莫西林后5小时和9小时，血液美沙酮浓度分别为0.23毫克/升和0.14毫克/升。对阿莫西林混悬液进行美沙酮检测，发现其浓度为2.4克/升。患儿逐渐好转，于第4天状况良好出院。调配抗生素的药店是当地美沙酮维持治疗项目的调配中心，美沙酮意外与抗生素混合。
在本病例中，社区药店将美沙酮与抗生素无意中混合导致了近乎致命的后果。文献检索显示，此前有两份关于儿童口服抗生素制剂后出现阿片类药物毒性的报告。
加拿大调配美沙酮的药店需要迅速采取行动，以尽量减少未来此类错误的发生。全科医生、儿科医生和急诊科医生应认识并怀疑儿童中这种罕见的阿片类药物毒性原因。对于意识水平下降和瞳孔缩小的患者，无论是否有呼吸抑制，无论是否有阿片类药物摄入史，都应考虑给予纳洛酮治疗。
