Klimek L, Aderhold C, Sperl A
Zentrum für Rhinologie und Allergologie, HNO-Universitätsklinik Mannheim, An den Quellen 10, 65183, Wiesbaden, Deutschland.
HNO. 2013 May;61(5):409-15. doi: 10.1007/s00106-012-2599-6.
In 2009, over 40 million prescriptions for antibiotic drugs were counted in outpatient medical care in Germany. This represents a turnover of more than 750 million euros. With over 80 million daily defined doses (DDD), amoxicillin was the most frequently prescribed antibiotic in Germany in 2008. Given the average of 5775 DDD per doctor, otolaryngologists prescribed more antibiotics than specialists in any other field of medicine in 2008; approximately 82% of these were β-lactams and tetracyclines.
This article is based on selective literature-based research using the PubMed database. The keywords used in the search were:"allergy","anaphylaxis" and"hypersensitivity", in combination with "penicillin","cephalosporin","carbapenem","cotrimoxazole","macrolide","aztreonam" and"tetracycline".
Allergic reactions to antibiotics are among the most frequently reported adverse side effects arising from drug treatment. However, non-allergic adverse side effects owing to drug intolerance are also very common and may be clinically indistinguishable from allergic reactions. Owing to a frequent lack of appropriate diagnostic investigation, the decision to withhold effective standard treatments from patients is often based solely upon anamnestic observations. Up to 10% of respondents in an unselected population report an allergy to penicillin. In 80% of these cases, however, no penicillin-specific IgE-antibodies can be detected.
A detailed understanding of the symptoms, diagnostic options and possible cross reactions pertaining to allergic reactions to antibiotics, as well to non-allergic adverse side effects with similar clinical appearance, is very important for otolaryngologists. This profound knowledge ensures that the correct diagnostic steps are taken and that appropriate treatment decisions prevent the unnecessary use of reserve antibiotics.
2009年，德国门诊医疗中抗生素药物的处方量超过4000万份。这意味着营业额超过7.5亿欧元。2008年，阿莫西林以超过8000万的日限定剂量（DDD）成为德国最常开具的抗生素。鉴于每位医生平均开具5775个DDD，2008年耳鼻喉科医生开具的抗生素比其他任何医学领域的专科医生都多；其中约82%为β-内酰胺类和四环素类。
本文基于对PubMed数据库的选择性文献研究。搜索中使用的关键词为：“过敏”“过敏反应”和“超敏反应”，并与“青霉素”“头孢菌素”“碳青霉烯类”“复方新诺明”“大环内酯类”“氨曲南”和“四环素”组合。
抗生素过敏反应是药物治疗中最常报告的不良反应之一。然而，由于药物不耐受引起的非过敏性不良反应也非常常见，并且在临床上可能与过敏反应难以区分。由于经常缺乏适当的诊断调查，不给患者使用有效标准治疗的决定往往仅基于既往观察。在未经过筛选的人群中，高达10%的受访者报告对青霉素过敏。然而，在这些病例中，80%检测不到青霉素特异性IgE抗体。
对于耳鼻喉科医生来说，详细了解与抗生素过敏反应以及临床表现相似的非过敏性不良反应相关的症状、诊断方法和可能的交叉反应非常重要。这种深入的知识可确保采取正确的诊断步骤，并做出适当的治疗决定，避免不必要地使用备用抗生素。
