Wilson J T, Burr I M
Am J Dis Child. 1975 Oct;129(10):1208-9. doi: 10.1001/archpedi.1975.02120470054015.
Infant twins sustained severe circumoral and pharyngeal burns from a concentrated solution of benzalkonium (Zephiran) chloride prescribed for treatment of candidiasis. This report emphasizes the unnecessary hazard accompanying use of a potentially toxic drug-especially when prepared in error by the pharmacist-when a safer drug (nystatin) is available for treatment of oral candidiasis. Risks from use of a prescription drug for other than the intended patient are also highlighted by this episode of poisoning.
一对婴儿双胞胎因用于治疗念珠菌病而开具的浓缩苯扎氯铵（洁尔灭）溶液遭受了严重的口周和咽部烧伤。本报告强调了使用一种潜在有毒药物所带来的不必要危害——尤其是当药剂师错误配制时——而此时有更安全的药物（制霉菌素）可用于治疗口腔念珠菌病。这起中毒事件还凸显了将处方药用于非指定患者所带来的风险。
