University of South Carolina College of Pharmacy, Columbia, SC, USA.
Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA.
Am J Health Syst Pharm. 2022 Jul 8;79(14):1146-1150. doi: 10.1093/ajhp/zxac098.
Eravacycline (ERV) is often used for drug-resistant gram-negative and nontuberculous mycobacteria (NTM) infections, but infusion site reactions are a potential adverse effect. We report a case of severe hypoesthesia secondary to ERV infusion.
A 74-year-old man presented with dyspnea, shortness of breath, and hemoptysis after being treated for community-acquired pneumonia. On the basis of respiratory cultures performed several weeks before the index hospitalization, he was diagnosed with Mycobacterium chelonae pneumonia. On hospital day (HD) 2, the infectious diseases consult team, guided by susceptibilities, initiated a regimen of azithromycin, levofloxacin, and ERV 80 mg (1 mg/kg) intravenously every 12 hours infused over 1 hour in 250 mL of normal saline. Approximately 25 minutes after the ERV infusion began, the patient reported tingling and numbness in his fingers, hands, and mouth, with shooting pain in his head. Symptoms resolved with cessation of the ERV infusion. On HD 3, the same ERV dose and volume was administered with an extended infusion time of 2 hours. The patient experienced the same reaction after 58 minutes, which ceased shortly after the infusion was stopped. Use of ERV was subsequently discontinued. The Naranjo adverse drug reaction probability scale score was 9, indicating a definite reaction. A review of the Food and Drug Administration Adverse Event Reporting System through March 2021 identified 22 ERV-associated events. Among these, 18% appear to be related to ERV infusions. Published results from phase 3 clinical trials did not document any hypoesthesia. It is unknown whether there is a correlation between concentration, dose, or infusion time and associated reactions.
This is a unique case of severe hypoesthesia secondary to ERV infusion leading to drug discontinuation. More data are needed to determine effective mitigation strategies.
依拉环素（ERV）常用于治疗耐药革兰氏阴性菌和非结核分枝杆菌（NTM）感染，但输液部位反应是一种潜在的不良反应。我们报告了一例因 ERV 输注引起的严重感觉减退病例。
一名 74 岁男性因社区获得性肺炎接受治疗后出现呼吸困难、呼吸急促和咯血。根据指数住院前数周进行的呼吸道培养，他被诊断为嗜肺军团菌肺炎。住院第 2 天（HD），传染病咨询小组根据药敏试验结果，开始使用阿奇霉素、左氧氟沙星和 ERV 80mg（1mg/kg），每 12 小时静脉滴注一次，在 250ml 生理盐水内输注 1 小时。ERV 输注开始约 25 分钟后，患者报告手指、手和嘴刺痛和麻木，头部有刺痛感。停止 ERV 输注后症状缓解。HD3 时，给予相同剂量和体积的 ERV，但延长输注时间至 2 小时。患者在 58 分钟后再次出现相同反应，输注停止后不久即停止。随后停止使用 ERV。Naranjo 药物不良反应概率量表评分为 9，表明为明确反应。通过对 2021 年 3 月前的美国食品和药物管理局不良事件报告系统进行审查，确定了 22 例与 ERV 相关的事件。其中，18%似乎与 ERV 输注有关。3 期临床试验的发表结果并未记录任何感觉减退。尚不清楚浓度、剂量或输注时间与相关反应之间是否存在关联。
这是一例因 ERV 输注引起的严重感觉减退导致药物停用的独特病例。需要更多数据来确定有效的缓解策略。
