Ertapenem使用與癲癇發作相關性

Seizures Associated with Ertapenem Use

陳佳南(Chia-Nan Chen) ； 賴輝雄(Hui-Hsiung Lai) ； 陳佳文(Char-Wen Chen) ； 林慧娟(Hui-Chuan Lin) ； 許永居(Yung-Chu Hsu)

《臺灣臨床藥學雜誌》 25卷4期 (2017/10) Pp. 312-318

https://doi.org/10.6168/FJCP.2017.2504.06

摘要

目的：經由文獻回顧，ertapenem誘發癲癇案例是少見。我們希望藉由回溯性研究和評估ertapenem引起癲癇與潛在疾病相關性，進而建立預防機制。方法：本研究採用病歷回溯的方式，收集分析自2008年11月01日至2015年07月31日期間，因使用ertapenem導致癲癇發作且通報至藥物不良反應資訊系統的個案。結果：病歷回溯符合納入對象共有14個個案。其中男性及女性各占50%，平均年齡為62.7 ± 14.7歲。根據Naranjo評分評估得分範圍從3至5分，其中2個案相關性為「可能的」和12個案為「可能性高」。曾有中樞神經異常者占71.4%，其中有2位服用抗癲癇藥物(antiepileptic drugs, AEDs)且其中1位曾發生過癲癇。分析個案的腎功能，肌酐清除率(creatinine clearance, CrCl) ＜ 30ml/min者有7位(50%)。而癲癇的發生在ertapenem開始使用後平均天數5.7±3.7天(範圍1~15天)。結論：一般來說，ertapenem引起癲癇發生率很低。然而，根據ertapenem與癲癇相關的可能性，臨床上使用ertapenem應保持警惕，尤其用在年長、中樞神經系統疾病或腎功能異常的患者。

關鍵字

Ertapenem ； 癲癇 ； 中樞神經毒性

並列摘要

Objective: Base on literature review, ertapenem induced seizure was scarce. This research investigated the relationship between the ertapenem-associated seizure and underlying diseases, thereby establishing prevention mechanisms. Methods: We performed a retrospective chart review for patients who were received at least one dose of ertapenem before seizure episode during the hospital course from November 1, 2008 to July 31, 2015 and were notified to the adverse drug reaction information system. Results: Chart reviews for 14 patients were conducted. The mean age of the study population was 62.7 ± 14.7 years and 50% of the patients were male. The Naranjo Adverse Drug Reaction Probability Scale fall in the score between 3 and 5 and revealed a causality relationship graded as ＂possible＂ in two episodes and ＂probable＂ in the remaining twelve episodes. Ten patients (71.4%) had CNS disorders, 2 of whom had taken anticonvulsants and one of whom had a seizure. According to patients' renal function reports, the number of patients with creatinine clearance (CrCl) ≤ 30 ml/min was seven (50%). The average time of the onset of seizures was 5.7 ± 3.7 days (ranging from 1 to 15 days) after the start of therapy. Conclusions: The incidence of seizure complicated due to ertapenem was very low. Nevertheless, clinicians should be vigilant regarding the possibility of ertapenem associated seizure, especially administering it to patients with elder, central nervous system (CNS) disorders, or patients with renal dysfunctions.

並列關鍵字

Ertapenem ； Seizure ； Central Nervous System Toxicity