摘要
目的:分析1例白细胞减少的准广泛耐药(pre-extensively drug-resistant,pre-XDR)肺结核患者使用康替唑胺的临床实践过程,为类似耐药结核病患者探索有效的抗结核治疗方案提供参考。方法与结果:患者4个月前被确诊为pre-XDR肺结核,并予贝达喹啉+利奈唑胺+氯法齐明+环丝氨酸+丙硫异烟胺抗结核治疗;治疗20 d后,反复出现头晕、多梦、易醒等症状;1 d前,再次出现难以入睡症状并伴烦热感和右膝关节疼痛,遂入院治疗;住院期间,患者多次出现白细胞减少情况,考虑为利奈唑胺骨髓抑制所致,服用利可君片亦不能改善,临床在斟酌后决定停用利奈唑胺,改用康替唑胺,之后白细胞水平果然明显恢复;此外,患者反复出现的难以入睡症状考虑为环丝氨酸的中枢神经毒性反应,而住院期间出现的Q-T间期延长则考虑是贝达喹啉所致,遂决定停用此二药;最后,患者的抗结核方案被调整为康替唑胺+氯法齐明+阿米卡星+乙胺丁醇+丙硫异烟胺,之后患者未再出现不适症状和指标异常。结论:pre-XDR肺结核属于较为难治的疾病,治疗时用药较多且复杂,很容易发生药物不良反应,并且部分药物不良反应可能会导致严重不良后果;对此,临床应采取积极干预措施,并及时调整抗结核治疗方案,以保证患者的用药安全和治疗效果。
Objective:To analyze the clinical practice process of using contezolid in a leukopenic patient with pre-extensively drug-resistant(pre-XDR) pulmonary tuberculosis,and provide reference for exploring effective antituberculosis treatment regimens for similar patients with drug-resistant tuberculosis.Methods and Results:The patient was diagnosed with pre-XDR pulmonary tuberculosis 4 months ago and was given anti-tuberculosis treatment with bedaquiline + linezolid + clofazimine + cycloserine + prothionamide;after 20 days of treatment,symptoms such as dizziness,dreaminess,and easy awakening occurred repeatedly;1 day ago,the symptom of difficulty in falling asleep occurred again,accompanied by fever and right knee joint pain,so the patient was hospitalized.During hospitalization,the patient developed leukopenia for many times,which was considered to be caused by bone marrow suppression with linezolid,and it was not improved after taking Leucogen Tablets.After careful consideration,it was decided to discontinue linezolid and change to contezolid;later,the white blood cell level recovered obviously;in addition,the patient's recurring symptom of difficulty in falling asleep was considered to be toxic reactions of central nerves caused by cycloserine,and the prolongation of Q-T interval during hospitalization was considered to be caused by bedaquiline,so it was decided to discontinue the two drugs.Finally,the patient's anti-tuberculosis regimen was adjusted to contezolid + clofazimine +amikacin + ethambutol + prothionamide,after which the patient no longer experienced uncomfortable symptoms and abnormal indicators.Conclusion:Pre-XDR pulmonary tuberculosis is a disease difficult to treat.The treatment involves multiple and complex medications,and adverse drug reactions are easy to occur,and some adverse drug reactions may lead to serious adverse consequences.Therefore,active clinical interventions should be taken and anti-tuberculosis treatment regimens should be adjusted in a timely manner to ensure the medication safety and treatment effect of patients.
作者
李祥
张宏
邝浩斌
LI Xiang;ZHANG Hong;KUANG Hao-bin(Department of Pharmacy,Guangzhou Thoracic Hospital,Guangzhou 510095,China;National Key Laboratory of Respiratory Diseases,Guangzhou Thoracic Hospital,Guangzhou 510095,China)
出处
《抗感染药学》
2024年第2期123-125,130,共4页
Anti-infection Pharmacy
基金
广州市科技计划项目(编号:2023B03J1303)。
关键词
康替唑胺
准广泛耐药肺结核
抗结核治疗
白细胞减少
利奈唑胺
环丝氨酸
贝达喹啉
contezolid
pre-extensively drug-resistant pulmonary tuberculosis
anti-tuberculosis treatment
leukopenia
linezolid
cycloserine
bedaquiline
