静脉滴注莫西沙星致精神异常

1例68岁男性患者因肺癌术后出现重症肺炎,静脉滴注莫西沙星400mg,17次／d。第4天夜间患者出现不自主自言自语。追问病史,得知其以往应用左氧氟沙星3d后曾出现类似情况并伴表情异常,停药后消失。遂停用莫西沙星,改用依替米星0．2g,27欠／d静脉滴注。4d后患者自言自语症状消失,出院前未再复发。     

静脉滴注莫西沙星致精神异常

1例79岁女性患者因医院获得性肺炎给予莫西沙星400mg,1次／d静脉滴注。当晚患者出现自言自语、焦虑,血压135／85mmHg（1mmHg=0．133kPa）。医嘱维持抗感染治疗。此后患者精神症状加重,表现为不认识家人、应答不切题、幻觉、狂躁不安等。应用莫西沙星5d后血压升至190／110mmHg,体温39．6℃,脑电图无异常。停用莫西沙星,改用美罗培南0．5g,1次／8h静脉滴注;并给予厄贝沙坦控制血压。2d后患者精神症状缓解,血压、体温恢复正常。2周后随访,出院后未再应用厄贝沙坦,血压基本正常,未再出现精神症状。     

莫西沙星致高龄患者精神异常

1例87岁女性患者,因胸闷、心慌加重伴喘息、咯痰给予莫西沙星0.4 g1、次/d口服,1 d后改为莫西沙星0.4 g、1次/d静脉滴注。第3天患者出现烦躁、谵语、神志模糊,应答不切题,夜间症状加重。停用莫西沙星,并给予地西泮肌内注射,2 d后上述症状消失。     

莫西沙星致老年患者精神和视觉异常

1例92岁男性慢性阻塞性肺疾病急性发作患者,因肺部感染静脉滴注莫西沙星400 mg,1次/d,头孢噻肟3.0 g,3次/d.第2天,患者出现胸闷、心慌、视觉异常、精神萎糜,之后出现烦躁、幻听、幻觉、谵妄、视觉异常加重.停用莫西沙星,继续使用头孢噻肟.次日,症状减轻,5 d后症状全部消失.     

莫西沙星治疗社区获得性肺炎的临床疗效观察

目的评价莫西沙星针剂治疗社区获得性肺炎的疗效和安全性。方法将72例社区获得性肺炎住院患者随机分为莫西沙星组(实验组,36例)和对照组(美洛西林/舒巴坦+阿奇霉素36例),疗程7～14 d。治疗前后观察临床症状、体征,进行X线胸片和实验室检查并对比分析。结果莫西沙星组与对照组的有效率分别为88.89%和86.11%,差异无统计学意义(P>0.05)。社区获得性肺炎患者对莫西沙星有较好的耐受性,且依从性好。结论莫西沙星治疗社区获得性肺炎安全有效。     

莫西沙星与阿托伐他汀钙联用相关横纹肌溶解

1例80岁男性患者,因脑梗死及高脂血症口服阿托伐他汀钙20 mg,1次/d。服药20 d后出现胸痛、胸闷、无力,实验室检查示肌酸激酶(CK)由130 U/L升至741 U/L,同时出现肾功能异常和电解质紊乱。第28天,患者因肺部感染给予莫西沙星注射液0.4 g静脉滴注,之后患者CK由741 U/L升至3565 U/L,停用阿托伐他汀钙;莫西沙星改为头孢哌酮舒巴坦钠。10 d后CK逐渐下降至54 U/L,其他血生化检查均恢复正常。     

腹部手术后应用莫西沙星对血糖的影响

目的：观察莫西沙星对腹部手术后患者血糖的影响。方法：对2010年5-11月37例来本院行腹部手术后血糖升高患者进行对比分析；将其随机分为治疗组21例和对照组16例，其中治疗组术后采用莫西沙星0．4g静点，1次，d，用药5～7d；对照组术后采用左氧氟沙星0．4g静点，1次／d，用药5～7d。对比观察两组患者的临床症状、体征、腹腔引流情况、血常规、血糖变化及不良反应。结果：莫西沙星抗感染作用强于左氧氟沙星，但两组比较，差异无统计学意义（P〉0．05）；莫西沙星对血糖无影响，左氧氟沙星对血糖略有影响，但两组比较，差异无统计学意义（挎0．05）。结论：莫西沙星对糖尿病患者的血糖不产生明显影响，但对外科术后引起的感染有明显抑制作用，可推荐作为感染合并糖尿病患者的首选用药。     

莫西沙星致头晕头痛1例

患者,男,56岁. 有慢性支气管炎病史,无精神、神经系统疾病史,有磺胺类药物过敏史. 近1周由于咳嗽、咳痰加重,于2008年1月7日来我院就诊. 体检：体温36.5 ℃,血压130/80 mmHg（1 mmHg ＝0.133 kPa）,神清,双肺呼吸音粗,可闻及细湿啰音,心脏及腹部无异常,双下肢不肿,胸片示肺纹理增粗、紊乱,血常规：WBC12.0×109•L^-1. 诊断为慢性支气管炎急性发作. 给予莫西沙星片0.4 g,qd,po. 医嘱连用5 d,同时应用盐酸氨溴索片. 第1 天服药后,诉头晕、恶心,考虑患者既往应用环丙沙星时曾出现眩晕症状,且患者无发作性头痛病史,遂嘱其停用莫西沙星,改服头孢克肟胶囊,当天症状消失. 第3天患者自行再次用莫西沙星1.5 h后,患者即出现头晕、头痛、恶心,为胀痛,且伴胸闷、烦躁. 体检显示生命体征均正常,无意识障碍,脑CT检查未见异常. 嘱其停药观察,第4天上述症状消失,继续用头孢克肟、盐酸氨溴索治疗,至慢性支气管炎症状缓解,未出现上述症状.     

莫西沙星治疗老年社区获得性肺炎临床研究

目的探讨莫西沙星治疗老年社区获得性肺炎的临床疗效。方法 100例患者,将其分为对照组(50例)与观察组(50例),两组患者的疗程均为10 d,对照组给予1次/d静脉连续点滴左氧氟沙星(400 mg),观察组给予1次/d静脉连续点滴莫西沙星注射液(400 mg),患者症状明显改善后改为1次/d口服莫西沙星片(400 mg)。观察莫西沙星治疗老年社区获得性肺炎的临床疗效。结果观察组的临床疗效明显高于对照组,差异有统计学意义(χ2=8.21,P<0.05)。观察组的细菌疗效明显高于对照组,差异有统计学意义(χ2=7.18,P<0.05)。两组患者均有患者出现,两组间副反应发生率差异无统计学意义(P>0.05)。副反应均较轻,患者可耐受,不影响治疗,经对症处理后缓解。结论莫西沙星治疗老年社区获得性肺炎疗效显著,值得临床推广应用。     

莫西沙星治疗慢性阻塞性肺疾病急性加重期的临床分析

目的：探讨莫西沙星治疗慢性阻塞性肺疾病（COPD）急性加重期的临床效果。方法：将172例慢性阻塞性肺疾病急性发作期的患者随机分为两组,其中观察组86例,给予莫西沙星注射液400mg静脉滴注,每日1次,疗程5d,后改为莫西沙星400mg口服,每日1次,疗程3d;对照组86例给予左氧氟沙星0.4g静脉滴注,每日1次,5d后改为0.2g口服,每日2次,连用3d,观察组与对照组均治疗8d,为1个疗程。观察8d后两组患者症状、体征、胸部X线片以及血常规等指标的变化。结果：莫西沙星在治疗慢性阻塞性肺疾病急性加重期中显效率明显高于左氧氟沙星对照组,不良反应发生率观察组为4.7％,对照组为10.5％。结论：莫西沙星治疗慢性阻塞性肺疾病急性加重期具有疗效好,安全性高,经济实惠,值得临床大力推广。     

右佐匹克隆致共济失调

1例68岁男性溃疡性结肠炎重度活动期患者使用激素冲击治疗后出现睡眠障碍,给予右佐匹克隆3 mg口服、1次/每晚以改善睡眠。用药次日,患者出现头晕、行走时头部下垂、身体歪斜等共济失调症状。患者既往有帕金森综合征病史,服用多巴丝肼疗效明显。怀疑为多巴丝肼引起的运动障碍,停用该药并予对症治疗3 d,患者症状未改善。请神经内科...     

替考拉宁与盐酸万古霉素致严重水疱型药疹

1例74岁男性患者,因直肠癌根治术后出现咳嗽、咯痰、发热约1个月,先后给予拉氧头孢钠、比阿培南、莫西沙星、替考拉宁、盐酸万古霉素、利柰唑胺和达托霉素治疗。在应用替考拉宁12d后换用莫西沙星,应用莫西沙星的第4天,患者四肢及躯干部位出现充血性皮疹伴瘙痒感。停用莫西沙星、改用盐酸万古霉素并给予抗过敏对症治疗后患者皮疹好转。应用盐酸万古霉素第8天,患者四肢再次出现红疹,停用盐酸万古霉素并换用替考拉宁。应用替考拉宁第5天患者皮疹加重,部分皮疹表面出现水泡并连接成片,换用利奈唑胺并继续抗过敏治疗,陈旧水泡逐渐吸收,未再出现新发水疱。考虑可能为替考拉宁引起的迟发型过敏反应,不排除还存在与盐酸万古霉素交叉过敏的可能。     

Elevated hepatic transaminases associated with telithromycin therapy: a case report and literature review.

PURPOSE: A case of mild hepatocellular injury associated with the administration of telithromycin in a patient with no risk factors for hepatotoxicity is presented. SUMMARY: A 44-year-old man with no significant past medical history arrived at the emergency room after six days of high fever, chills, headache, neck stiffness, and back pain. Five days earlier, he visited a family medicine clinic for his symptoms and oral telithromycin 800 mg daily was prescribed for a suspected upper-respiratory-tract infection. The patient stopped taking the drug after three days due to persistent symptoms. On admission, the patient's laboratory tests revealed an aspartate transaminase (AST) concentration of 68 units/L, an alanine transaminase (ALT) value of 155 units/L, and an erythrocyte sedimentation rate of 40 mm/hr. The patient was not taking any long-term medications, had taken only aspirin for his fever, and denied the use of alcohol and illegal drugs. The patient was admitted to the general medical unit with a diagnosis of possible viral hepatitis. His urine culture was negative, and serology tests later revealed no evidence of hepatitis A, B, or C. Ibuprofen, pantoprazole, and enoxaparin were prescribed. On hospital day 2, the patient's AST and ALT concentrations had decreased to 50 and 110 units/L, respectively. By day 3, the patient's symptoms had improved and he remained afebrile. His AST and ALT values had further decreased to 41 and 105 units/L, respectively. He was then diagnosed with acute viral upper-respiratory-tract infection with mild hepatotoxicity associated with telithromycin and was discharged home with orders for follow-up at the family medicine clinic. CONCLUSION: A patient without risk factors for hepatotoxicity developed mild elevations in hepatic transaminases after receiving telithromycin for the treatment of a suspected upper-respiratory-tract infection.     

静脉滴注莫西沙星致过敏性休克

1例75岁女性患者因腰椎手术后预防感染给予盐酸莫西沙星注射液0.4 g(250ml)静脉滴注。用药约10 min后,患者突感全身不适,皮肤湿冷,大汗,心率130次/min,呼吸26次/min,血压57/37 mmHg(1 mmHg=0.133 kPa)。考虑为莫西沙星导致的过敏性休克,立即停用莫西沙星,给予心电监护、鼻导管吸氧、先后静脉注射盐酸肾上腺素注射液0.5 mg、呋塞米注射液10 mg、硝酸甘油注射液2.5 mg,酒石酸美托洛尔片12.5 mg舌下含服。80 min后症状缓解,心率88次/min、呼吸18次/min,血压95/54 mmHg。     

Propranolol-induced depression and psychosis

Episodes of depression and acute psychosis in two patients receiving propranolol hydrochloride are described, and the literature on propranolol-induced depression and psychosis is reviewed. A 42-year-old woman developed severe depression, marked apathy, social withdrawal, and anorexia after taking propranolol hydrochloride (80 mg/day) for three months to control her hypertension. Five days after the dose was reduced to 40 mg/day, there was a major improvement in her depressive symptoms, with a complete resolution in eight days. Upon rechallenge with 80 mg/day of propranolol, she again experienced depressive symptoms. Atenolol 50 mg/day was substituted for the propranolol therapy, and she exhibited a complete remission of her depression. The second patient was a 63-year-old man who had been taking propranolol hydrochloride 160 mg/day for three months without incident. Because of an increased frequency of anginal attacks, the dosage was increased to 240 mg/day. Within two days, he demonstrated such agitation, excitement, and combativeness that he had to be controlled with a 25-mg dose of methotrimeprazine. When the propranolol dose was reduced to 160 mg/day, his psychotic symptoms rapidly cleared. However, when the dose was subsequently increased to 200 mg/day, he again showed increased agitation. After substituting atenolol 100 mg/day for propranolol, the patient's mental status returned to normal. Both of these patients experienced symptoms that were temporarily associated with propranolol. Both patients were subsequently controlled without symptoms with atenolol therapy. Propranolol is a highly lipophilic beta blocker that achieves high concentrations in the brain. When continued beta-blocking therapy is necessary or beta blockade is indicated, a weakly lipophilic agent such as atenolol is indicated.     

口服盐酸莫西沙星片致罕见不良反应1例

1例55岁女性患者因尿路感染口服盐酸莫西沙星1片,半小时后,患者出现全身发热伴皮肤瘙痒、呼吸急促、声音嘶哑、喉头水肿、血糖升高等不良反应急诊就医,经16d治疗后症状全部消失。     

盐酸莫西沙星注射液和苦参碱注射液配伍稳定性考察

目的：考察莫西沙星注射液和苦参碱注射液的配伍稳定性,为临床用药安全提供实验依据。方法：模拟临床常用浓度和配制方法,观察莫西沙星注射液和苦参碱注射液配伍后,在8h内配伍液的外观、pH值,并采用高效液相色谱法（HPLC）测定其含量变化。结果：配伍溶液的外观和p H值无明显变化,苦参碱和盐酸莫西沙星8h内其相对百分含量无明显变化。结论：在25℃和37℃下,苦参碱和盐酸莫西沙星配伍后8h内是稳定的。     

喹诺酮类药物致血小板减少不良反应文献分析

目的分析喹诺酮类药物左氧氟沙星和莫西沙星引起药物性血小板减少病例及其临床特点,为临床安全用药提供参考。方法通过检索PubMed、Medline数据库、中国学术期刊全文数据库、维普中文科技期刊数据库,搜集喹诺酮类药物左氧氟沙星和莫西沙星致血小板减少的不良反应个例报道,并对患者性别、年龄以及基础疾病、合并用药、给药途径、临床表现以及预后情况进行统计分析。结果共搜集10例使用左氧氟沙星和6例使用莫西沙星后发生了血小板减少的不良反应病例报道。62.5%该类不良反应发生在60岁以上高龄患者;68.75%病例有高血压、糖尿病等基础慢性疾病史;除1例患者死亡外,其余患者在停药后5~40天内转归,不良反应类型为严重药品不良反应。结论喹诺酮类药物引起血小板减少不良反应的报道较少,但后果较严重,临床应用应早期及时监测,并及时给予对症处理。