Cabo H A, Castro Rios M, de Montes de Oca N F
Med Cutan Ibero Lat Am. 1986;14(3):177-80.
One to 10% of the cases have cutaneous reactions caused by ampicillin. When this drug is associated to MI the percentage goes up to 90% of the cases. The physiopathogenic mechanism of the generalized exanthema in this association is unknown. The development of toxicity is postulated because these patients have no previous history of allergy to penicillin either before of after the cutaneous reaction. By a still obscure mechanism, MI predisposes or alters the patient sensibility to the drug and the cutaneous reaction appears. This picture cannot be attributed to MI because the exanthema that present is mild. Neither is this picture of allergy due to ampicillin, without relationship with the MI, because the reaction is not coincident with other descriptions of reactions by this drug. The clinic evidence, observed in patients with MI, and ampicillin, is of a strong relation between two factors and the cutaneous reaction. In our patient the eruption affected principally the sites exposed to the sun, that makes us think in a phototoxicity reaction. Despite this fact the tests done were negative. We agree with other authors that the administration of ampicillin in patients with ill-defined pharyngeal symptoms is contraindicated until infections mononucleosis is ruled out.
1%至10%的病例会出现由氨苄西林引起的皮肤反应。当这种药物与心肌梗死(MI)相关时,该比例会升至90%。这种关联中全身性皮疹的生理致病机制尚不清楚。毒性的发生被推测是因为这些患者在皮肤反应之前或之后都没有青霉素过敏史。通过一种仍不清楚的机制,心肌梗死使患者对药物的敏感性增加或发生改变,从而出现皮肤反应。这种情况不能归因于心肌梗死,因为出现的皮疹很轻微。这也不是与心肌梗死无关的氨苄西林过敏情况,因为该反应与这种药物其他反应的描述不一致。在心肌梗死患者和氨苄西林患者中观察到的临床证据表明,这两个因素与皮肤反应之间存在密切关系。在我们的患者中,皮疹主要影响暴露于阳光的部位,这使我们想到光毒性反应。尽管如此,所做的检查结果为阴性。我们同意其他作者的观点,在排除传染性单核细胞增多症之前,禁忌对有不明确咽部症状的患者使用氨苄西林。