Grice Karen T, Day Sarah A
Karen T. Grice, Pharm.D., is Clinical Pharmacist, Department of Pharmacy, Grant Medical Center, Columbus, OH; at the time of writing, she was Pharmacy Practice Resident, Grant Medical Center. Sarah A. Day, Pharm.D., BCPS, is Clinical Pharmacist, Critical Care, Department of Pharmacy, Doctors Hospital, Columbus.
Am J Health Syst Pharm. 2014 Apr 1;71(7):558-61. doi: 10.2146/ajhp130345.
Pharmacotherapy challenges in a case of late latent syphilis complicated by end-stage renal disease and presumptive penicillin allergy are described.
A 58-year-old white woman was admitted to the hospital for symptoms including altered mental status, shortness of breath, and chest pain. The initial workup isolated syphilis immunoglobulin G antibody. A treponemal test was reactive, and a nontreponemal test was nonreactive; analysis of cerebrospinal fluid did not indicate neurosyphilis. The patient was diagnosed as having late latent syphilis of unknown duration, for which the standard treatment is intramuscular penicillin G benzathine 2.4 million units once weekly for three weeks. Given the patient's advanced renal disease and other serious comorbidities, there were concerns about the potential need for renal dosage adjustment and repeated desensitization. However, given the slow absorption and long half-life of penicillin G and published data indicating its safe use in the context of hemodialysis, the treating clinicians decided to proceed with penicillin G therapy at the usual dose after an oral penicillin desensitization protocol; repeat desensitization before two subsequent injections was not performed. The patient completed the full course of penicillin G without incident. Notably, skin testing was not performed to definitively establish penicillin allergy. Microbiological testing to determine a cure of syphilis was not performed.
After the completion of an oral desensitization protocol, the standard three-dose regimen of intramuscular penicillin G for late latent syphilis was safely administered to a hemodialysis patient without dosage adjustment or repeated desensitization.
描述一例晚期潜伏梅毒合并终末期肾病且疑似青霉素过敏患者的药物治疗挑战。
一名58岁白人女性因精神状态改变、呼吸急促和胸痛等症状入院。初步检查发现梅毒免疫球蛋白G抗体。梅毒螺旋体检测呈阳性，非梅毒螺旋体检测呈阴性；脑脊液分析未提示神经梅毒。该患者被诊断为病程不明的晚期潜伏梅毒，其标准治疗方案为苄星青霉素G 240万单位，每周一次，共注射三周。鉴于患者的晚期肾病和其他严重合并症，人们担心可能需要调整肾脏剂量并反复进行脱敏治疗。然而，考虑到青霉素G吸收缓慢、半衰期长，且已发表的数据表明其在血液透析情况下可安全使用，治疗临床医生决定在口服青霉素脱敏方案后按常规剂量进行青霉素G治疗；在随后的两次注射前未进行重复脱敏。患者顺利完成了青霉素G的整个疗程。值得注意的是，未进行皮肤试验以明确确定青霉素过敏。未进行微生物检测以确定梅毒是否治愈。
在完成口服脱敏方案后，晚期潜伏梅毒的标准三剂量肌肉注射青霉素G方案在未调整剂量或反复脱敏的情况下安全地应用于一名血液透析患者。
