Voeten M, Landstra A M, Maseland M H H, van Setten P A
Ziekenhuis Rijnstate, Postbus 9555, 68oo TA Arnhem.
Ned Tijdschr Geneeskd. 2007 Jun 9;151(23):1299-303.
Two patients, a girl and a boy, both aged 8.5 years, presented with serious side effects caused by ceftriaxone and co-trimoxazole, respectively. The first patientwas treated with ceftriaxone (100 mg/kg/day with a body weight of 35.6 kg) on suspicion of a neuroborreliosis, but developed an acute cholecystitis with cholelithiasis 3 weeks after the antibiotic had been withdrawn. He underwent a laparoscopic cholecystectomy. Ceftriaxone binds calcium in the biliary tract, forming biliary sludge or stones. The second patient developed thrombocytopenia during treatment with co-trimoxazole (58 mg/kg/day with a body weight of 25.4 kg) because of a urinary-tract infection. After discontinuation of the co-trimoxazole the thrombocytopenia resolved spontaneously. The pathophysiological mechanism involved may be either a direct toxic effect of trimethoprim or an immune-mediated reaction to sulfamethoxazole. According to current guidelines, the dosage of the drug was too high in both cases. It is important to ensure a correct dosage in children, since side effects are potentially dose-related.
两名患者，一名女孩和一名男孩，均为8.5岁，分别出现了由头孢曲松和复方新诺明引起的严重副作用。第一名患者因疑似神经莱姆病接受头孢曲松治疗（体重35.6千克，剂量为100毫克/千克/天），但在停用抗生素3周后出现了急性胆囊炎伴胆结石。他接受了腹腔镜胆囊切除术。头孢曲松在胆道中与钙结合，形成胆泥或结石。第二名患者因尿路感染在接受复方新诺明治疗（体重25.4千克，剂量为58毫克/千克/天）期间出现血小板减少症。停用复方新诺明后，血小板减少症自行缓解。所涉及的病理生理机制可能是甲氧苄啶的直接毒性作用或对磺胺甲恶唑的免疫介导反应。根据现行指南，在这两种情况下药物剂量都过高。确保儿童用药剂量正确很重要，因为副作用可能与剂量相关。
