Anaphylactic reaction secondary to a medication administration error in a patient receiving intravenous antibiotics.

The occurrence of either medication administration errors or adverse drug reactions (ADRs) in hospitalized patients are well documented events. The combination of the two sequelae to drug therapies can lead to potentially life threatening episodes. In the case reported here, a medication administration error led to an ADR which threatened the life of a 12-month-old boy. The patient was receiving doses of cefotaxime sodium and nafcillin sodium, and was inadvertently administered a dose of cefoxitin sodium through a nursing staff medication administration errors. The patient experienced marked flushing; pitting edema, tachycardia, and a rapid respiration rate. Wheezing was absent. The patient recovered spontaneously after discontinuance of the inappropriately administered cefoxitin sodium dose, and discontinuance of cefotaxime sodium as well. Pharmacists must remain diligent in the review of the drug use process in institutions. Appropriate reconstitution, labeling, and dispensing of prescribed IV medications does not necessarily lead to appropriate administration of the drug. Pharmacy staff reviewal of the medication administration process must be carried out in conjunction with the nursing staff to ensure appropriate drug use. Patient and professional alike will benefit from such actions.     

细辛脑静脉滴注致过敏性休克

1例58岁女性,因患上呼吸道感染先后给予头孢噻肟钠4.0g＋5%葡萄糖氯化钠注射液250ml和细辛脑8mg＋5%葡萄糖注射液250ml静脉滴注治疗。输注头孢噻肟钠时无不良反应,后输入细辛脑注射液约20ml时出现头昏、恶心、腹痛、呕吐、意识丧失及血压下降等休克症状,BP85/42mmHg,HR60次/min。立即停药,给予吸氧及葡萄糖酸钙、肾上腺素、异丙嗪等治疗。5min后血压恢复正常。因患者既往曾多次使用头孢噻肟钠治疗,无不良反应发生,因此考虑该过敏性休克和细辛脑注射液相关。     

呋塞米静脉推注相关过敏性休克

1例44岁女性前庭神经炎患者为改善循环、降低颅压,先后给予银杏叶注射液20 ml/d静滴和呋塞米10 mg/d静推.第3天,在呋塞米开始静推后约1 min,患者出现全身皮疹、头晕、胸闷、心慌、出冷汗、面色苍白、呼吸困难等症状,BP 60/35 mm Hg.立即停用呋塞米,给予吸氧、地塞米松、肾上腺素及异丙嗪治疗,0.5 h后患者呼吸平稳、皮疹消失,BP 110/60 mm Hg.继续使用银杏叶注射液治疗,上述症状未再出现.     

复方氨基酸静滴致过敏反应

患者女,55岁,于2000年10月25日晨8时入院,因咳嗽、咳痰6d,加重并喘息9h,门诊以"支气管哮喘",收住内科,既往有"支气管哮喘病史2年,对"青霉素、鱼腥草、磺胺类、维生素K1"等多种药物过敏.查体:T 36.7℃,P 80次·min-1,R 20次·min-4,BP110/70mmHg,高枕卧位,呼吸急促,咽部充血;双肺呼吸音粗糙,布满哮鸣音,HR 80次·min-1,心音尚可,节律齐;腹部无异常.     

复方水溶性维生素静滴致过敏性反应2例

例1女,68岁。因患慢性胃炎,于2003年1月27日来我院住院治疗。患者既往无药物不良反应史。因患者体质虚弱,营养不良,给予注射用复方水溶性维生素500mg加入5%葡萄糖注射液500ml,静滴,qd。治疗至第4天,滴注药液约10min时,患者自觉胸闷、气促、出冷汗,立即停止输液。查体:P46次·min-1,BP100/60mmHg(1mmHg=0.133kPa),心电图示心脏交界性逸搏。立即给予地塞米松注射液5mg、肾上腺素0.3mg,加0.9%氯化钠注射液稀释后静注。5min后症状缓解,逐渐消失。例2男,65岁。因原发性肝癌、高血压Ⅲ级,于2003年1月1日由门诊收入院治疗。患者既往无药物不良反…     

氯化钾静脉滴注致婴儿过敏反应

1例5月龄女婴，因感染性腹泻伴轻度脱水，静脉滴注10％葡萄糖注射液250ml＋10％氯化钠注射液8ml＋10％氯化钾注射液3ml。静脉滴注5min后，患儿出现寒战、发热、呼吸困难。停止输液，给予地塞米松治疗后好转。第2天又输入同样液体，再次发生过敏反应。第3天停用氯化钾，其他药物不变，继续补液，未出现过敏反应。     

亚胺培南／西司他丁静脉输注引发过敏反应

1名30岁女性行剖宫产术患者，手术当日至术后5d，体温波动在37．7～39．5℃之间，经细菌培养证实为大肠埃希菌感染，给予亚胺培南／西司他丁500mg＋0．9％氯化钠注射液250ml静脉滴注，15min后患者出现寒战、心慌、呼吸困难等症状，立即停药。给予吸氧、物理降温、激素等治疗。45min后患者症状缓解，2．5h后体温为38．4℃。     

Cost effectiveness of adding folinic acid to fluorouracil plus levamisole as adjuvant chemotherapy in patients with colon cancer in Germany

OBJECTIVE: To assess the cost effectiveness of the addition of folinic acid to fluorouracil plus levamisole in patients with colon cancer from the perspective of the German Social Health Insurance. STUDY DESIGN AND METHODS: Patients with International Union Against Cancer (Union International Contre Cancer; UICC) II/T(4) or UICC III colon cancer enrolled in an open-label randomised clinical trial in Germany (Forschungsgruppe Onkologie Gastrointestinaler Tumoren-1 [FOGT-1]) received either fluorouracil plus levamisole (A, standard) or fluorouracil plus levamisole and folinic acid (B) for 12 months as adjuvant chemotherapy after curative intended surgery. Outcome measures for economic evaluation were disease-free life-years gained (df-LYG) and overall life-years gained (LYG) derived from the respective Kaplan-Meier survival curves. Direct medical costs from the perspective of the German Social Health Insurance were estimated retrospectively (2000 values) and incremental cost-effectiveness ratios (ICERs) were calculated. A Markov model was used to project the trial results beyond 5 years for the patients' remaining life expectancy. RESULTS: Adding folinic acid to the fluorouracil/levamisole regimen results in an increase in time to progression and survival in patients with locally advanced colon cancer. Within the trial period of 5 years ICERs (B versus A) were 33,008 Euro per df-LYG and 51,225 Euro per LYG (costs and effects discounted at 5%). The Markov model yielded ICERs of 11,176 Euro per df-LYG and 11,020 Euro per LYG (costs and effects discounted at 5%). The model was robust for variations of key variables in the sensitivity analysis. CONCLUSIONS: Results of this cost-effectiveness analysis suggest that the addition of folinic acid offers clinical benefits at additional costs which are likely to be acceptable for decision makers in the long term. Cost-effectiveness ratios calculated within the clinical trial period were just above 50,000 Euro/LYG. Because treatment benefits, i.e. prolonged survival, are sustained beyond 5 years whereas incremental costs are mainly incurred in the first year, results of the Markov model yielded cost-effectiveness ratios that compare more favourably with other published ICERs.     

Hypersensitivity reaction following chloramphenicol administration in a patient with typhoid fever

Hypersensitivity reactions due to chloramphenicol are rarely reported in the literature. We present a case report of a patient with typhoid fever who experienced a hypersensitivity reaction subsequent to the infusion of chloramphenicol sodium succinate. The patient had previously reacted similarly to ampicillin infusion. A brief review of reported cases of chloramphenicol hypersensitivity in the English-language literature, as well as possible alternative explanations in this case, are provided.     

核糖核酸Ⅱ静脉滴注致过敏性休克

患者男,63岁。以胃体小弯侧腺癌,于2005年12月23日收入院。既往无药物过敏史和其他病史。查体:T37.2℃,P85次/m in,R20次/m in,BP105/55m m H g(1m m H g=0.133kPa),神志清,精神尚可,发育正常,自主体位,皮肤黏膜无黄染、出血点及皮疹。入院后于2006年1月10日全麻下行胃大部切除术。术后常规应用抗炎、抑酸、补液、抗肿瘤治疗。并给予0.9%氯化钠注射液100m l加注射用核糖核酸Ⅱ0.3g静脉滴注。第1天滴注6m in后病人感全身不适、呼吸困难、憋气、全身大汗,查体:BP测未及,H R98次/m in,脉搏细速,R25次/m in,氧饱和度67%,全身无皮疹,双侧瞳…     

对1例晚期结肠癌患者的药学监护

1例52岁女性患者,结肠癌术后1年余,发现双肺转移瘤1 d入院。入院后给予FOLFIRI方案化疗,临床药师对患者进行用药注意事项教育,对药物不良反应进行监测,指导护士以正确顺序给药,建议临床医师加用阿托品降低伊立替康的不良反应,患者最终顺利完成本周期治疗。     

Adjuvant chemotherapy for localised colon cancer. Fluorouracil + folinic acid for node-positive, non-metastatic disease

The standard treatment for colon cancer is surgical excision. Adjuvant chemotherapy is intended to reduce the risk of relapse, which is responsible for the death of nearly half of all patients treated surgically for localised disease. After surgery for stage III disease (node involvement without metastases), the 5-year survival rate is about 63% with adjuvant chemotherapy combining fluorouracil and folinic acid, versus 51% with placebo, a statistically significant difference. After surgery for stage II disease (tumour spread beyond the intestinal wall but no node involvement), a meta-analysis updated in 2008 showed no impact of adjuvant chemotherapy on the overall survival rate. Fluorouracil + folinic acid administration according to the de Gramont protocol is the standard adjuvant treatment. The addition of regional fluorouracil chemotherapy did not further improve outcome in a trial in 1501 patients with stage II or stage III disease. The fluorouracil precursors, capecitabine and tegafur, provide no advantages in terms of efficacy or tolerability. These oral drugs have not been compared with the de Gramont protocol. A trial comparing raltitrexed versus fluorouracil + folinic acid was stopped because of an excess of deaths in the raltitrexed arm. In two large trials, each including more than 2000 patients, the addition of oxaliplatin to the fluorouracil + folinic acid combination (Folfox 4 protocol) in patients with stage III disease appeared to slightly improve overall survival in patients under 65 years of age, but severe neuropathy, diarrhoea, nausea and vomiting were more frequent. In three trials in a total of more than 3000 patients with stage III disease, the addition of irinotecan did not improve the efficacy of the fluorouracil + folinic acid combination, while serious adverse effects were more frequent. No new drugs intended for the treatment of colon cancer have been introduced since 2006, but better evaluation of existing drugs means that patients with stage III colorectal cancer can now be offered a choice between standard intravenous fluorouracil and oral capecitabine or tegafur. Oxaliplatin adjunction is another option for patients under 65. The adverse effect profile is an important factor in the choice of treatment.     

司氟沙星致过敏性休克

患者女,21岁。因子宫炎伴少量出血,于2003年7月7日来院就诊。既往无药物过敏史。给予司氟沙星(巴沙)治疗。患者首次服用1片,服药2h后,患者于四肢、颈、面部出现少量红疹,逐渐蔓延至全身,全身无力,立即来院就诊。入院时查体发现患者面部、四肢、背部、腹部布满红疹和红斑,口唇发绀,呼吸急促,随后意识不清。测血压为73/43mmHg(1mmHg=0.133kPa),考虑为司氟沙星片所致的过敏性休克。立即给予患者平卧,保持呼吸道畅通,吸氧,给予10%葡萄糖酸钙10ml,地塞米松5mg,iv。10min后,休克症状得到缓解,血压升至93/55mmHg,再次给予地塞米松5mg加入10%葡萄…     

Acyclovir-induced bullous reaction in a patient with metastatic breast cancer

Acyclovir is a synthetic guanosine analog, which is a potent and highly selective inhibitor of the DNA polymerases of several herpes viruses. Acyclovir is known as a relatively safe drug with few significant adverse effects, of which nephrotoxicity seems to be the most dreaded one. On the other hand, inflammation and phlebitis at the injection site have been reported to be the most frequent side effects of intravenous acyclovir administration. Although exceptionally rare, there have been case reports of bullous eruption occurring after intravenous acyclovir therapy, a similar of which we have also observed. Here, we present a case of localized bullous eruption and phlebitis associated with intravenous acyclovir treatment in a patient with metastatic breast cancer. Our case distinctively demonstrated two consequential juxtaposing vesiculobullous lesions and phlebitis manifesting as erythema along the course of a vein after intravenous acyclovir injection. We emphasize this hardly known side effect and importance of early recognition and appropriate management of unpredictable side effects of widely used medications.     

Safe administration of iron sucrose in a patient with a previous hypersensitivity reaction to ferric gluconate

A 67-year-old woman with iron deficiency anemia required parenteral iron therapy and was treated with intravenous ferric gluconate. She tolerated the first dose, but after the second dose, she developed a tingling feeling all over her body, along with swelling in her hands and feet, and a rash with hives over most of her body. It was thought that she had likely experienced a hypersensitivity reaction to ferric gluconate. The decision was made to continue therapy; however, two modifications were made. The patient was given dexamethasone, diphenhydramine, and ibuprofen 1 hour before administering the third dose, and the infusion time was prolonged by 1 hour. Approximately 45 minutes after the infusion was completed, the patient developed hives on her arms and legs. At the patient's next clinic visit, it was decided that continuation of parenteral iron repletion was necessary, and the decision was made to attempt a challenge with iron sucrose. The patient was given dexamethasone 8 mg to be taken the night before and the morning of treatment. She successfully completed the iron repletion therapy with iron sucrose. Three parenteral iron products are available in the United States: iron dextran, sodium ferric gluconate complex, and iron sucrose. Iron dextran, the oldest of these products, carries the highest risk for hypersensitivity reactions. Available data suggest that either iron sucrose or ferric gluconate can be safely administered to patients with known hypersensitivity to iron dextran. Our patient's experience implies that it may be possible to safely administer iron sucrose to a patient with hypersensitivity to ferric gluconate. This finding has clinical implications and warrants confirmation in a larger population.