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口服用抗生物質と重篤な皮膚不良反応のリスク
Erika Y Lee1,2,3, Tara Gomes3,4,5, Aaron M Drucker2,3,6
1Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA
|August 8, 2024
まとめ
サルフォナミドおよびセファロスポリン抗生物質は,マクロリドと比較して,高齢者における深刻な皮膚性副作用 (cADRs) のリスクが最も高い. 処方する人は,適当な場合には,より低リスクの抗生物質の選択肢を検討すべきである.
科学分野:
- 薬用警戒について
- 薬物安全性
- 臨床薬理学
背景:
- 重篤な皮膚不良反応 (cADRs) は,重度の過敏反応であり,有意な罹病率と死亡率を有する.
- 抗生物質はcADRの一般的な原因ですが,異なる抗生物質のクラス間の比較リスクデータは限られています.
研究 の 目的:
- 老人における様々な口服抗生物質クラスに関連した深刻なcADRのリスクを比較する.
- cADRで入院した患者の臨床結果について説明する.
主な方法:
- カナダのオンタリオ州 (2002年−2022年) で,リンクされた行政データセットを用いて,ネストケース・コントロール研究が行われました.
- 経口抗生物質を投与した66歳以上の成人を対象に,症例は処方後60日以内にED訪問またはcADRのために入院した.
- マクロライドを基準群として,条件付きロジスティック回帰を用いて関連性を推定した.
主要な成果:
- サルフォナミド (aOR 2. 9) とセファロスポリン (aOR 2. 6) はマクロリドと比較して重症なcADRと最も高い関連性を示した.
- 他の関連抗生物質には,ニトロフラントイン (aOR2. 2),ペニシリン (aOR1. 4),およびフルオロキノロン (aOR1. 3) が含まれていた.
- セファロスポリンとスルフォナミドは,処方箋毎のcADRの最も高い粗製率を示した. 入院した患者は,長期滞在,重症治療の移送,および死亡に直面した.
結論:
- 一般的に処方される経口抗生物質,特にスルフォナミドとセファロスポリンでは,高齢者の深刻なcADRのリスクが増加します.
- 臨床的決定は,cADRのリスクを軽減するために実行可能な場合,低リスクの抗生物質を好むべきである.
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