Wełnicki Marcin, Buksińska-Lisik Małgorzata, Mamcarz Artur
3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, Bursztynowa 2, 04-479 Warsaw, Poland.
Antibiotics (Basel). 2021 Jan 3;10(1):38. doi: 10.3390/antibiotics10010038.
According to current European Society of Cardiology guidelines, for staphylococcal prosthetic valve endocarditis, rifampicin should be one of the drugs used. However, there is a concomitant need for vitamin K antagonists in patients with mechanical prostheses. It is widely known that rifampicin interacts with vitamin K antagonists (VKA), and this interaction makes it difficult to maintain the INR (international normalized ratio) value in the therapeutic range. We present two clinical cases of staphylococcal prosthetic valve endocarditis patients. Two different strategies for dealing with adverse drug interactions have been applied. In the first case, the dose of warfarin was up-titrated until the optimal INR value was obtained. In the second case, due to the history of labile INR values, a decision was made to modify the dosage of warfarin, taking into account pharmacological aspects of drug interactions.
根据欧洲心脏病学会目前的指南，对于葡萄球菌人工瓣膜心内膜炎，利福平应作为使用的药物之一。然而，机械瓣膜置换患者同时需要使用维生素K拮抗剂。众所周知，利福平与维生素K拮抗剂（VKA）相互作用，这种相互作用使得难以将国际标准化比值（INR）维持在治疗范围内。我们展示了两例葡萄球菌人工瓣膜心内膜炎患者的临床病例。应用了两种不同的策略来处理药物不良反应。在第一个病例中，华法林剂量逐步增加直至获得最佳INR值。在第二个病例中，由于INR值不稳定的病史，考虑到药物相互作用的药理学因素，决定调整华法林的剂量。
