Departments of Emergency Medicine and Medicine, Upstate Medical University, Syracuse, NY.
Am J Health Syst Pharm. 2011 Jun 1;68(11):1012-4. doi: 10.2146/ajhp100603.
A case of coagulopathy in a pre-adolescent with cerebral palsy that developed after chronic prophylactic antibiotic use is reported.
An 11-year-old boy with cerebral palsy was brought to the emergency department experiencing restlessness and decreased oxygen saturation. Evaluation of the patient revealed gallstone-related pancreatitis, with elevated serum amylase and lipase concentrations and abnormal liver function test results. At the time of the initial evaluation, the International Normalized Ratio (INR) was 6.54 (normal range, 0.8-1.2), and the activated partial thromboplastin time was 53.8 seconds (normal range, 24.4-34.8 seconds). The boy's medication history included use of azithromycin 200 mg every other day for about two years for antiinflammatory therapy. On confirmation of the elevated INR 2 hours after the initial evaluation, azithromycin was discontinued, and a single dose of phytonadione 2 mg was administered. About 14 hours after phytonadione administration, the INR had declined to 0.94; 43 hours later, the INR remained within the normal range without further phytonadione therapy. Using the probability scale of Naranjo and colleagues, this case was rated as a probable drug-related adverse event. Previous reports have linked the development of vitamin K deficiency and impaired coagulation to long-term antibiotic use, but not specifically to use of azithromycin or other macrolide antibiotics.
An elevated INR in a child with cerebral palsy was evidently related to long-term therapy with azithromycin. The abnormal INR normalized after discontinuation of azithromycin and administration of one dose of phytonadione.
报告一例患有脑瘫的青春期前儿童在长期预防性使用抗生素后出现凝血功能障碍的病例。
一名 11 岁脑瘫男孩因躁动不安和氧饱和度降低而被送往急诊科。对患者的评估显示与胆石症相关的胰腺炎，血清淀粉酶和脂肪酶浓度升高，肝功能试验结果异常。在初始评估时，国际标准化比值（INR）为 6.54（正常范围为 0.8-1.2），活化部分凝血活酶时间为 53.8 秒（正常范围为 24.4-34.8 秒）。该男孩的用药史包括使用阿奇霉素 200mg 每隔一天进行约两年的抗炎治疗。在初始评估后 2 小时确认 INR 升高后，停止使用阿奇霉素，并给予单剂量的叶绿醌 2mg。叶绿醌给药后约 14 小时，INR 降至 0.94；43 小时后，INR 仍在正常范围内，无需进一步使用叶绿醌治疗。根据 Naranjo 同事的概率量表，该病例被评为可能与药物相关的不良事件。先前的报告将维生素 K 缺乏和凝血功能障碍的发展与长期使用抗生素联系起来，但与长期使用阿奇霉素或其他大环内酯类抗生素无关。
脑瘫儿童 INR 升高显然与长期使用阿奇霉素有关。停用阿奇霉素并给予一剂叶绿醌后，异常 INR 恢复正常。
