JAMA最新文章青霉素过敏不再必要

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JAMAInsightsJuly4,PenicillinAllergyIsNotNecessarilyForeverJasonA.Trubiano,N.FranklinAdkinson,ElizabethJanePhillipsJAMA.;(1):82-83.doi:10./jama..

Penicillinallergyisoftendiagnosedearlyinlife,andthehistoryofpenicillinallergypersistsinapatient’smedicalrecordformanyyearswithoutverification.Somephysicians’considerationofapatienthavingpenicillinallergyisbasedonpatientexperiencethatmayhaveoccurredearlyinchildhood.Thisresultsintheuseofalternateantibioticsthatarelesseffective,moretoxicandexpensive,andthathaveinappropriatelybroadercoveragethanpenicillin.1Accumulatingevidencesuggeststhatexcessiveuseofunnecessarilybroad-spectrumantibioticsincreasestheriskofantibioticresistance,includingClostridiumdifficileinfection.2Theinabilitytouseanantistaphylococcalpenicillin(eg,nafcillin)forpatientswithmethicillin-susceptibleStaphylococcusaureussepsisorotherseriousinfectionsforwhichpenicillinsarethefirst-linetherapy(eg,ampicillinforEnterococcusfaecalisorbenzathinepenicillinforsyphilis)placespatientsatriskoftreatmentfailure,resistancegeneration,andincreasedmortality.

青霉素过敏常常在患者年轻时即已诊断，青霉素过敏史从此出现在患者病历中，历经多年不再证实。一些医生对患者青霉素过敏的诊断基于患者在儿童阶段的经历。这一结果导致患者只能使用疗效较差、毒性更强、价格昂贵的其他抗生素，与青霉素相比其抗菌谱更广。越来越多的证据提示，过度使用不必要的广谱抗生素增加抗生素耐药的风险，包括难辨梭状芽孢杆菌感染。如果对MSSA感染或其他青霉素作为一线治疗药物的严重感染（如氨苄青霉素治疗粪肠球菌感染，苄星青霉素治疗梅毒）患者不能使用抗葡萄球菌青霉素（如奈芙西林），则患者治疗失败率增加，发生耐药及死亡风险也相应增加。

Mostpatientswhohaveahistoryofpenicillinallergyarenotreallyallergictopenicillin.Approximately10%ofallpatientsintheUnitedStatescarryalabelofpenicillinallergy,2yetlessthan10%ofthosewithpenicillinallergyhistorieswhoaretestedinspecializedallergyclinicsarefoundtobeatriskforacuteallergytopenicillins.3Truepencillinallergyissomewhatraresinceonly1%ofthegeneralpopulationisactuallyallergictopenicillin.Falseattributionofpenicillinallergymightoccurbecauseviralrashesinchildrenmaybemistakenforpenicillinallergywhenthesechildrenareunnecessarilygivenantibioticsforaviralsyndrome.Patientsmayhavehadadocumentedacutepenicillinreactioncausedbyallergic(IgE)antibodies,butthoseantibodiesdeclineandcandisappearwithtime,resultinginmostpatientsbe







































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