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β-内酰胺类过敏的管理及影响

Management and Implications of Beta-Lactam Allergies.

作者信息

Zavaleta-Monestel Esteban, Webster Keyla, Rojas-Chinchilla Carolina, Muñoz-Gutierrez Gabriel, Díaz-Madriz José Pablo

机构信息

Pharmacy, Hospital Clinica Biblica, San Jose, CRI.

Pharmacy, Universidad de Ciencias Médicas, San Jose, CRI.

出版信息

Cureus. 2024 May 14;16(5):e60281. doi: 10.7759/cureus.60281. eCollection 2024 May.

DOI:10.7759/cureus.60281
PMID:38872647
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11170240/
Abstract

Beta-lactam antibiotics are essential components in the current antimicrobial treatment strategy, playing a crucial role in ambulatory patients and hospitalized patients. Despite their prominent therapeutic index, the use of beta-lactam can lead to adverse effects, with allergic reactions being the most concerning because of their severity. Additionally, the phenomenon of cross-reactivity may occur among various beta-lactam families, with side chains significantly contributing to immunological recognition, making these structures often responsible for the cross-allergic reactivity of beta-lactams. Tools to assess beta-lactam allergy include taking a patient's medical history, performing skin tests, and conducting provocation tests. This research aims to analyze the relevant aspects related to the safe administration of beta-lactam antibiotics in hospitalized patients as well as provide knowledge on the proper management of patients with such hypersensitivity, by doing systemic research. This research was made using Google Scholar and keywords such as "Beta-lactam allergy," "Hypersensitivity," "Cross-reactivity," "Desensitization," and "Beta-lactam allergy management." In conclusion, substituting a beta-lactam antibiotic with an alternative antibiotic may not always be the best management option for these patients, as it may lead to more adverse effects, be less effective, and prolong hospitalization time. It may also result in higher rates of antibiotic-resistant infections and increased medical costs, as these alternatives are often more expensive. However, an alternative within the beta-lactam family can be sought by conducting the appropriate analyses. Although cross-reactivity does not always occur among all beta-lactams, potential cross-reactivity should always be considered.

摘要

β-内酰胺类抗生素是当前抗菌治疗策略的重要组成部分,在门诊患者和住院患者中发挥着关键作用。尽管其治疗指数突出,但使用β-内酰胺类抗生素可能会导致不良反应,其中过敏反应因其严重性而最为令人担忧。此外,不同β-内酰胺类家族之间可能会出现交叉反应现象,侧链在免疫识别中起重要作用,使得这些结构常常导致β-内酰胺类抗生素的交叉过敏反应。评估β-内酰胺类抗生素过敏的工具包括询问患者病史、进行皮肤试验和激发试验。本研究旨在通过系统研究,分析与住院患者安全使用β-内酰胺类抗生素相关的各个方面,并提供关于此类过敏患者正确管理的知识。本研究使用谷歌学术搜索以及“β-内酰胺类抗生素过敏”、“超敏反应”、“交叉反应”、“脱敏”和“β-内酰胺类抗生素过敏管理”等关键词。总之,用另一种抗生素替代β-内酰胺类抗生素对这些患者来说可能并不总是最佳管理选择,因为这可能会导致更多不良反应、疗效降低以及住院时间延长。这还可能导致抗生素耐药性感染率升高和医疗成本增加,因为这些替代药物通常更昂贵。然而,可以通过进行适当分析来寻找β-内酰胺类家族内的替代药物。尽管并非所有β-内酰胺类抗生素之间都会发生交叉反应,但始终应考虑潜在的交叉反应。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a877/11170240/4eb2ccf06a73/cureus-0016-00000060281-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a877/11170240/e0b74fb70d4d/cureus-0016-00000060281-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a877/11170240/4eb2ccf06a73/cureus-0016-00000060281-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a877/11170240/e0b74fb70d4d/cureus-0016-00000060281-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a877/11170240/4eb2ccf06a73/cureus-0016-00000060281-i02.jpg

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Analysis of a beta-lactam allergy assessment protocol challenging diverse reported allergies managed by an antimicrobial stewardship program.一项β-内酰胺类过敏评估方案的分析,该方案对由抗菌药物管理计划处理的各种报告过敏情况提出了挑战。
Antimicrob Steward Healthc Epidemiol. 2023 Sep 8;3(1):e153. doi: 10.1017/ash.2023.432. eCollection 2023.
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Direct challenges are the gold standard for most antibiotic allergy evaluations.
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Ann Allergy Asthma Immunol. 2023 Oct;131(4):427-433. doi: 10.1016/j.anai.2023.03.033. Epub 2023 Apr 8.
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Drug Allergy Practice Parameter Updates to Incorporate Into Your Clinical Practice.药物过敏实践参数更新,纳入您的临床实践。
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