King B A, Geelhoed G C
Emergency Department, Princess Margaret Hospital for Children and School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
J Paediatr Child Health. 2003 Dec;39(9):677-81. doi: 10.1046/j.1440-1754.2003.00267.x.
To review presentations to Princess Margaret Hospital Emergency Department (PMH ED) with adverse joint and skin reactions associated with the use of oral antibiotics, to describe the clinical course of children with cefaclor-related serum sickness-like reactions (cefaclor SSLR) and compare these with cases reported to the Adverse Drug Reactions Advisory Committee (ADRAC).
Twelve-month retrospective review of presentations to a tertiary paediatric ED (42,000 visits annually) via an ED computer database search and review of medical charts of children presenting with joint or skin reactions. Telephone interviews were conducted with the caregivers of children with cefaclor SSLR.
Adverse skin or joint reactions occurred in 150 children; 70 after cefaclor alone, 10 after cefaclor in combination with other antibiotics and 70 after other antibiotic courses. SSLR occurred in 44 children; 32 after cefaclor alone, five after cefaclor in combination with other antibiotics and seven after other single antibiotics. In children with cefaclor SSLR, otitis media was the most common indication (59.4%), another 18.8% had viral illnesses. Prolonged sequelae occurred in four children, a situation not previously reported. Sixty reports of paediatric cefaclor SSLR were made to ADRAC during the study period, none originated from PMH ED.
Cefaclor was associated with 53.3% of oral antibiotic related skin and joint adverse reactions and 84.1% of SSLR. The indications for its use in paediatric illness require careful reconsideration. ADRAC data under-represents the incidence of cefaclor SSLR.
回顾向玛格丽特公主医院急诊科（PMH ED）就诊的与口服抗生素使用相关的关节和皮肤不良反应情况，描述头孢克洛相关血清病样反应（cefaclor SSLR）患儿的临床病程，并与上报给药物不良反应咨询委员会（ADRAC）的病例进行比较。
通过急诊科计算机数据库搜索和查阅出现关节或皮肤反应患儿的病历，对一家三级儿科急诊科（每年就诊42,000人次）进行为期12个月的回顾性研究。对患有cefaclor SSLR的患儿的照料者进行电话访谈。
150名儿童出现皮肤或关节不良反应；仅使用头孢克洛后出现的有70例，头孢克洛与其他抗生素联合使用后出现的有10例，使用其他抗生素疗程后出现的有70例。44名儿童出现cefaclor SSLR；仅使用头孢克洛后出现的有32例，头孢克洛与其他抗生素联合使用后出现的有5例，使用其他单一抗生素后出现的有7例。在患有cefaclor SSLR的儿童中，中耳炎是最常见的适应症（59.4%），另有18.8%患有病毒性疾病。4名儿童出现了长期后遗症，这是之前未报告过的情况。在研究期间，向ADRAC上报了60例儿科cefaclor SSLR病例，均非来自PMH ED。
头孢克洛与53.3%的口服抗生素相关皮肤和关节不良反应以及84.1%的cefaclor SSLR有关。其在儿科疾病中的使用适应症需要仔细重新考虑。ADRAC的数据未能充分反映cefaclor SSLR的发生率。
