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題名 | 抗生素引起肝損傷之文獻回顧=Review of Antibiotics-Induced Liver Injury |
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作者 | 吳信鈴; 陳琦華; | 書刊名 | 藥學雜誌 |
卷期 | 28:4=113 2012.12[民101.12] |
頁次 | 頁91-95 |
分類號 | 418.281 |
關鍵詞 | 抗生素引起肝損傷; 肝毒性; Antibiotics-induced liver injury; Liver toxicity; |
語文 | 中文(Chinese) |
中文摘要 | 本文回顧常用抗生素可能引起之肝損傷。抗生素引起的肝損傷在大多數情況下為特異體質反應。除了 trovafloxacin和 telithromycin外,普遍來說,嚴重肝毒性、肝衰竭發生機率是很相當低的。要診斷為抗生素導致的肝毒性,須先排除可能的疾病,因為缺乏客觀的診斷數據與特定的臨床表現,很難與肝膽疾病造成之肝臟病變作區隔,往往延遲診斷,而錯失停藥良機造成慢性肝損傷。透過大規模的研究,或全球性藥物安全監測報告顯示 amoxicillin/clavulanic acid, co-trimoxazole, flucloxacillin,發生機率比 macrolides, tetracycline, fluoroquinolone來的高。尋找抗生素導致肝損傷的相關線索,包括抗生素使用的時程及肝損傷的關連性、抗生素本身潛在肝毒性、伴隨有過敏免疫反應、曾發生藥物有關的肝損傷的病史、停藥後快速恢復正常肝功能等是評估是否為抗生素引起肝傷害的方法。依據研究報告顯示個別藥品造成之肝損傷有個別差異及特徵,如 trovafloxacin因導致嚴重肝衰竭而下市; amoxicillin/clavulanic acid導致肝臟毒性經常是發生於停藥後; telithromycin因嚴重肝衰竭案例,而被嚴格限制其用途;長期口服 minocycline可能造成脂肪肝。對於有高風險的患者而言,在使用肝毒性高的抗生素時,須仔細評估潛在風險與預期的效益,嚴密追蹤相關肝功能,一旦懷疑肝損害,儘快停藥後通常恢復良好。 |
英文摘要 | Antibiotics-induced hepatotoxicity is considered a type of idiosyncratic reaction. With the exception of trovafloxacin and telithromycin, antibiotic-induced severe hepatotoxicity is rarely seen. The diagnosis of antibiotics-induced hepatotoxicity is based on the suspicion of liver toxicity together with an exclusion of clinical causes due to absence of objective diagnostic tests and specific clinical manifestations. The causality attribution process produces an array of hepatic lesions that are often clinically indistinguishable from hepatobiliary diseases, lead to delayed diagnosis and chronic liver injury. The reported incidence of hepatic drug reactions of amoxicillin/clavulanic acid, co-trimoxazole, and flucloxacillin is higher than those of macrolides, tetracycline, fluoroquinolones through large-scale studies or worldwide pharmacovigilance reporting. The key element to demonstrate causality is a high degree of suspicion that any liver injury may be related to drug exposure, followed by an attentive research of toxic exposure, a consistent time sequence, an analysis of the hepatotoxic potential of identified agents, past history of drug-related liver injury, a response accompanied with immune-allergic reaction and a rapid return normal liver function test with cessation of suspected drugs. It is important to recognize the potential risks associated with antibiotics-induced hepatotoxicity to mitigate the risks. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。