静脉注射的阿西克洛维尔在可能的病毒性脑炎中过度使用吗? 一个回顾性审查
Anna Wakelin1, Anthony Wolff2, Heather Angus-Leppan3
1Internal Medicine Department, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK. anna.wakelin4@nhs.net.
Journal of neurology
|June 16, 2025
概括
对疑似脑膜炎的实证IV阿西克洛维尔并不总是合适的,增加风险. 审查其常规使用并专注于精神状态的改变可以改善病毒性脑炎的诊断.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 临床药理学 临床药理学
背景情况:
- 及时静脉注射 (IV) 乙克洛维尔对于治疗简单疹病毒 (HSV) 脑炎至关重要,降低死亡率.
- 病毒性脑炎的早期诊断受到非特异性症状和延迟的测试结果的阻碍.
- 由于毒性和神经毒性风险,目前的指导方针不支持对疑似脑膜炎的经验性IV阿西克洛维尔.
研究的目的:
- 评估疑似病毒性脑炎的诊断方法.
- 评估IV阿西克洛维尔处方在疑似中枢神经系统感染的患者中是否合适.
主要方法:
- 追溯的队列研究.
- 包括410名年龄超过16岁的患者,他们因怀疑中枢神经系统感染而被处方IV阿西克洛维尔.
- 数据收集于2021年12月至2024年2月的英国皇家自由伦敦NHS基金会信托.
主要成果:
- 29%的患者符合可能或可能的脑炎标准;5%没有.
- 38%的人缺乏针对HSV或疹病毒的微生物学或血清学检测.
- 最终诊断:5%的病毒性脑炎 (2%确诊),6%的脑膜炎,11%的妄.
结论:
- 对于疑似脑膜炎的常规经验IV阿西克洛维尔需要审查,与NICE指南保持一致.
- 改变精神状态是免疫能力强的患者病毒性脑炎和脑膜炎之间的关键区分因素.
- 要平衡诊断的不确定性与经验治疗的风险是必不可少的.
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