| 摘要: |
| β-内酰胺类抗生素是儿科使用率最高的一类药物，过敏反应是该类药物最常见的一种不良反应，严重者可发生过敏性休克导致死亡。关于β-内酰胺类抗生素在使用前是否进行皮肤过敏试验（简称皮试）一直存有争议。根据我们对国内55家医院开展的β-内酰胺类抗生素皮试现状调查结果，结合国内外文献，分析了β-内酰胺类抗生素发生过敏反应的机制与原因、β-内酰胺类抗生素皮试的价值与意义、国内外β-内酰胺类抗生素皮试的现状及国内皮试存在的问题；认为青霉素皮试是目前预测青霉素I型过敏反应最快捷、敏感、经济的方法，头孢菌素类、碳青霉烯类、单环类从科学性、规范性、经济性等方面综合考虑，目前的循证依据并不支持进行皮试；β-内酰胺类抗生素在国内至今还未形成统一的皮试规范，包括皮试标准试剂、操作方法和皮试液浓度、剂量以及皮试结果的判定标准，临床在皮试操作和皮试结果的正确解读存在困惑，建议国家政府层面加强统一规范，重视β-内酰胺类抗生素过敏反应的救治措施，防止和减少药物不良反应，避免药品浪费和大量人力物力消耗以及废弃物造成的环境污染，更好地促进β-内酰胺类抗生素的合理应用。 |
| 关键词: β-内酰胺类抗生素 药物过敏反应 现状 管理规定 规范皮试 迫切性 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2018.11.009 |
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| 基金项目: |
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| Urgency of Regulations for Skin Test by Government Based on Domestic and International Current Statusof β-Lactam Antibiotics |
| Cheng Qing1 , Wang Xiaochuan1 , Zhang Haixia2 , Zhao Xin2 , Wang Xiaoling1 |
| (1.National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China; 2.Hunan Children's Hospital, Hunan Changsha 410007, China) |
| Abstract: |
| β-lactam antibiotics are the most commonly used drugs in pediatrics, and anaphylaxis is one of the most common adverse drug reactions to these drugs, death can occur in severe cases due to anaphylactic shock. There has been controversy over whether β-lactam antibiotics should be tested for skin allergy (referred to as skin test) before application. According to the investigation of the β-lactam antibiotics skin test conducted in 55 hospitals from China, combined with the domestic and international literature, the mechanism and causes of anaphylaxis to β-lactam antibiotics, the value and significance of β-lactam antibiotics skin test, current status of β-lactam antibiotics skin test at home and abroad and existing problems in domestic skin test were analyzed. It is believed that penicillin skin test was the most rapid, sensitive and economical method for predicting penicillin type I anaphylaxis; cephalosporins, carbapenems and monocyclics were considered comprehensively from scientific, normative and economic aspects, and the current evidence basis did not support the skin test. Up to now, there has not been a unified skin test specification for β-lactam antibiotics in China, including standard reagent for skin test, methods of operation, concentration and dosage of skin test solution and criteria of skin test results. There was confusion in the correct interpretation of methods of operation and results of skin test in clinic. It is recommended that the national government should strengthen the unified norms, pay more attention to the treatment measures for anaphylaxis of β-lactam antibiotics, prevent and reduce adverse drug reactions, avoid drug waste and a large amount of human and material consumption and environmental pollution induced by waste, so as to better promote rational use of β-lactam antibiotics. |
| Key words: β-lactam antibiotics drug anaphylaxis status management provisions regulations for skin test urgency |
