Imipenem/Cilastatin使用於腎功能不全病人劑量過高引發癲癇案例報告

Imipenem/Cilastatin Over-Dose Induced Seizure in Patient with Renal Insufficiency: A Case Report

林秀如(Hsiu-Ju Lin) ； 李紀慧(Chi-Hui Lee) ； 莊美華(Mei-Hua Chuang)

《臺灣臨床藥學雜誌》 26卷2期 (2018/04) Pp. 165-171

https://doi.org/10.6168/FJCP.201804_26(2).0010

摘要

一位84歲女性病人因為泌尿道感染入院，給與經驗性抗生素ertapenem治療5天，因為感染情況未改善，改以抗生素imipenem/cilastatin (1,000 mg Q8H intravenous drip [IVD])做後續治療，使用兩個劑量後病人癲癇發作，給與抗癲癇藥物levetiracetam和lorazepam治療1天後症狀消除。依藥物不良反應相關性Naranjo score評分，此案例「可能」為imipenem/cilastatin未依照病人體重和腎功能調整劑量造成癲癇發作。雖然藥師在第一時間有提醒處方之住院醫師應調整，但醫師認為病人臨床感染問題應優先控制而拒絕更改劑量。藥師也未進一步與主治醫師溝通此問題，導致病人出現可預防副作用癲癇的發生。為了病人用藥安全，應該在醫療人員之間建立一個更好的溝通平臺。

關鍵字

Imipenem/Cilastatin ； 藥物不良反應 ； 腎功能 ； 癲癇發作 ； 可預防副作用

並列摘要

An 84-year-old woman was admitted to the emergency department for suspected urinary tract infection. An empirical antibiotic of ertapenem was given for 5 days and then shifted to intravenous imipenem/cilastatin (1,000 mg every eight hours) due to poor clinical response. After two doses of imipenem/cilastatin, the patient developed a seizure attack, which was controlled after the administration of levetriactam and lorazepam for 1 day. According to the algorithm of Naranjo score, this adverse drug reaction was graded as ＂probable＂. That is, the seizure attack was probably associated with the unadjusted doses of imipenem/cilastatin. Although the clinical pharmacist had informed the resident doctor about this concern, further follow up or communication was not performed. Unfortunately, patient experienced the preventable adverse effect. It is essential to establish an efficient communication platform between healthcare professionals to improve patient safety.

並列關鍵字

Imipenem/Cilastatin ； Adverse Drug Reaction ； Renal Function ； Seizure Attack ； Preventable Adverse Effect