Stockholm Cystic Fibrosis Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
Br J Clin Pharmacol. 2022 Nov;88(11):4845-4853. doi: 10.1111/bcp.15434. Epub 2022 Jun 16.
Drug hypersensitivity reactions (DHR) to antibiotics are common and a substantial issue in managing patients with cystic fibrosis (CF). This study aimed to assess the prevalence and clinical features as well as risk factors of DHR to antibiotics in CF.
A 20-year retrospective study was conducted among 226 CF patients (100 children and 126 adults) attending our centre. The Swedish Registry for Cystic Fibrosis and electronic medical records enabled us to ascertain the number and routes of antibiotic courses. All suspected DHR were evaluated.
The patients had a total of 16 910 antibiotic courses, of which 6832 (40%) were intravenously administered. Of 226 enrolled CF patients, 70 (31%) developed overall 131 DHR to antibiotics. The prevalence of DHR increased with advancing age (P < .001). Beta-lactams elicited 71% of all DHR and piperacillin was the most common single culprit (30% of intravenous and 24% of all DHR). Reactions were mild to moderate and mostly limited to skin; no severe cutaneous adverse reactions were observed. Additionally, anaphylaxis was rare, constituting 2.3% (3/131) of all DHR. Patients with DHR were exposed to significantly more courses of antibiotics than those without DHR (median 124 vs. 46, retrospectively, P < .001).
DHR to antibiotics, particularly to beta-lactams, are increased in CF patients, and associated with a higher number of cumulative exposures because of recurrent infections. However, severe cutaneous or systemic DHR, such as anaphylaxis, appear to be rare.
抗生素药物过敏反应（DHR）在囊性纤维化（CF）患者的管理中较为常见，也是一个重要问题。本研究旨在评估 CF 患者对抗生素药物 DHR 的发生率、临床特征和危险因素。
对在我院就诊的 226 例 CF 患者（100 例儿童和 126 例成人）进行了一项为期 20 年的回顾性研究。瑞典囊性纤维化登记处和电子病历使我们能够确定抗生素疗程的数量和途径。所有疑似 DHR 均进行了评估。
患者共接受了 16910 次抗生素疗程，其中 6832 次（40%）为静脉给药。在纳入的 226 例 CF 患者中，共有 70 例（31%）发生了总共 131 例抗生素药物 DHR。DHR 的发生率随年龄增长而增加（P<0.001）。β-内酰胺类药物引起的 DHR 占所有 DHR 的 71%，哌拉西林是最常见的单一致敏药物（静脉用药占 30%，所有 DHR 占 24%）。反应程度为轻至中度，主要局限于皮肤；未观察到严重皮肤不良反应。此外，过敏反应罕见，占所有 DHR 的 2.3%（3/131）。发生 DHR 的患者接受的抗生素疗程明显多于未发生 DHR 的患者（回顾性分析中位数分别为 124 次和 46 次，P<0.001）。
CF 患者对抗生素药物 DHR 的发生率增加，特别是对β-内酰胺类药物，这与反复感染导致的累积暴露次数增多有关。然而，严重的皮肤或全身 DHR，如过敏反应，似乎较为罕见。
