疑似Amoxicillin/Clavulanic Acid (Augmentin^®)引起的Stevens-Johnson Syndrome案例報告

Amoxicillin/Clavulanic Acid (Augmentin^®) Induced Stevens-Johnson Syndrome: A Case Report

謝蕙霞(Hui-Hsia Hsieh) ； 吳天元(Tien-Yuan Wu) ； 陳綺華(Chi-Hua Chen)

《臺灣臨床藥學雜誌》 24卷4期 (2016/12) Pp. 344-351

https://doi.org/10.6168/FJCP.2016.2404.10

摘要

盤尼西林類 (penicillins) 抗生素引起之皮膚異常反應是常見之藥物不良反應，通常在停用藥物後可逐漸恢復，但極少部分皮膚學異常反應如史蒂芬強森症候群(Stevens-Johnson syndrome, SJS) 的發生率非常罕見，發生率小於十萬分之一，較棘手且可能危及生命之藥物不良反應，藉由文獻回顧，本文探討此案例使用之amoxicillin/clavulanic acid (Augmentin^®) 引發SJS之成因、可能性及因應處理方式。本文報告一位直腸癌術後的病患，因肛門廔管使用口服amoxicillin/clavulanic acid(Augmentin^®)，三日後開始產生SJS 之嚴重藥物不良反應。在停用藥物及採取相關治療後、狀況趨穩定而出院繼續於門診追蹤照護。據統計約有一半的SJS 是因藥物引起，少部分是因疾病感染（如AIDS 或黴漿菌感染）或感染過程中為了控制感染症狀而使用抗生素所致。臨床常用藥品中以磺胺類 (sulfonamides) 抗生素、芳香環類抗癲癇劑、盤尼西林類 (penicillins) 抗生素約占藥物引起SJS 的三分之二。本文藉由案例報告提供醫療照護人員參考。

關鍵字

Amoxicillin/Clavulanic Acid (Augmentin®) ； Adverse Drug Reaction (ADR) ； Stevens-Johnson Syndrome (SJS)

並列摘要

Penicillin antibiotics induced skin abnormal adverse drug reactions can usually be gradually recovered after withdrawing the drug, but the incidence of the severe skin reactions such as Steven Johnson syndrome (SJS) is very rare, lower than 1/ 100,000. SJS is the life-threatening adverse drug reaction potentially. In this report, we discussed the possibility of induction of SJS by using amoxicillin/clavulanic acid (Augmentin^®) and the treatment after exposure. We reported a case of post-surgery colorectal cancer patient taking amoxicillin/ clavulanic acid (Augmentin^®). Severe SJS were occurred after taking amoxicillin/ clavulanic acid (Augmentin^®) for three days. After withdrawing the drug, the patient's condition has recovered and discharged on referring to outpatient care. We discussed the reasons, possibilities, and treatment for amoxicillin/clavulanic acid (Augmentin^®) induced SJS by literature review in this article. Statistically, around half of SJS cases are induced by the drugs, another small portion is due to infections (such as HIV or mycoplasma infections) or antibiotics applied for the symptoms controlled of infection. Sulfonamide antibiotics, aromatic class antiepileptic agents, penicillins are commonly used and account for about two-thirds of drug-induced SJS. We would like to report a colorectal cancer patient taking oral amoxicillin/clavulanic acid (Augmentin^®) following anal fistula and began to produce serious SJS adverse drug reactions after three days.

並列關鍵字

Amoxicillin/Clavulanic Acid (Augmentin®) ； Adverse Drug Reaction (ADR) ； Stevens- Johnson Syndrome (SJS)