Norrby S R
Department of Infectious Diseases, University of Umeå.
Drugs. 1987;34 Suppl 2:105-20. doi: 10.2165/00003495-198700342-00009.
Cephalosporins generally cause few side effects. Hypersensitivity reactions are less common than with the penicillins and modern studies have presented data contradicting a true cross-reactivity to cephalosporins in patients who have previously reacted to penicillins. Other hypersensitivity reactions to cephalosporins include fever, arthralgia and exanthema observed in two clusters of children who had been given cefaclor. Nephrotoxicity is not a problem with modern cephalosporins, although slight reductions of renal function have been seen when high doses of ceftazidime were used. Some of the new cephalosporins have a 3-methyl thiotetrazole side-chain, a moiety which confers a risk of reduced synthesis of prothrombin with subsequent risk of bleeding, and of disulfiram-like reactions in patients consuming alcohol following a cephalosporin dose. Other cephalosporins, e.g. ceftriaxone and cefoperazone, are excreted not only via the kidneys but also via the bile. This leads to high biliary concentrations of the active drug, increasing the risk of diarrhoea which may be caused by selection of cytotoxin-producing strains of Clostridium difficile. Laboratory adverse reactions to cephalosporins are rare. Eosinophilia and thrombocytosis are commonly reported, but are most probably not adverse reactions but signs of healing of the infections treated. Other haematological reactions have been reported in very few patients and have been rapidly reversible when treatment was stopped.
头孢菌素类药物一般引起的副作用较少。与青霉素相比，过敏反应不太常见，并且现代研究提供的数据与既往对青霉素有反应的患者对头孢菌素存在真正交叉反应的观点相矛盾。对头孢菌素的其他过敏反应包括在两组服用头孢克洛的儿童中观察到的发热、关节痛和皮疹。现代头孢菌素不存在肾毒性问题，尽管使用高剂量头孢他啶时曾观察到肾功能有轻微下降。一些新型头孢菌素含有3-甲基硫代四氮唑侧链，该部分会使凝血酶原合成减少，继而有出血风险，并且会使服用头孢菌素后饮酒的患者出现双硫仑样反应。其他头孢菌素，如头孢曲松和头孢哌酮，不仅通过肾脏排泄，还通过胆汁排泄。这会导致活性药物在胆汁中的浓度升高，增加由艰难梭菌产细胞毒素菌株的选择所引起的腹泻风险。头孢菌素类药物的实验室不良反应很少见。常见嗜酸性粒细胞增多和血小板增多，但很可能不是不良反应，而是所治疗感染愈合的迹象。其他血液学反应仅在极少数患者中报告，停药后可迅速逆转。
