2021 Volume 23 Issue 1 Published: 28 January 2021
  

  • Select all
    |
  • Cai Haodong
    Abstract ( ) PDF ( )
    The coronavirus disease 2019 (COVID-19) epidemic is facing the most critical situation. As of January 11, 2021, there have been nearly 90 million confirmed cases worldwide and nearly 2 million deaths. The local epidemic situation in China is sporadic and locally clustered, and the situation of epidemic prevention is difficult and complicated. In this situation, there are many problems in medication safety of patients, such as safety issues in off-label medication and compassionate medication of COVID-19 treatment, safety problems in the combination use of drugs for COVID-19 and drugs for other diseases, monitoring of adverse drug reactions in COVID-19 treatment, the safety issues in self-purchased drugs for prevention and treatment of COVID-19, and the medication safety in patients with other diseases during the epidemic. Therefore, it is necessary to pay more attention to the medication safety of patients to fight the epidemic scientifically and to win a greater victory in the fight against the COVID-19 epidemic at a smaller price.
  • Tian Danli, Xu Yangui
    Abstract ( ) PDF ( )
    The elderly are susceptible to a variety of diseases and the problem of multiple medications is common. Therefore, the rational use of medications in the elderly, especially the rational use of antibacterial drugs, is very important. The elderly have unique physiological and pathological characteristics. The decrease of immune function with aging and various factors such as malnutrition, primary disease, decreased mucosal barrier function, weakened cough reflex, and functional changes of the urinary tract system may increase the chance of infection in the elderly. Recommendations for the application of antibacterial drugs in the elderly include strictly grasping of the indications and selecting drug carefully, being alert to adverse drug-drug interactions, paying attention to the safety of drugs in new indications, and formulating individualized therapeutic regimen, etc. The irrational use of antibiotics not only increases the economic burden of patients, but also directly leads to the emergence of bacterial resistance. Clinicians should strictly grasp the indications of antibiotics, monitor the blood drug concentration as much as possible, formulate individualized drug administration plan, and pay attention to medication monitoring, so as to promote the medication safety in the elderly.
  • Li Xiaole, Guo Wei, Xu Yongsheng
    Abstract ( ) PDF ( )
    Objective To understand the clinical features of vancomycin-associated drug-induced hypersensitivity syndrome (DIHS) in children. Methods Case reports on vancomycin-associated DIHS in children were collected by searching the relevant databases home and abroad up to May 31, 2020. Patients′ relevant information (sex, age, primary disease, time from medication to onset of DIHS, main symptoms, organs and systems involved, hematological changes, RegiSCAR score, treatment and outcome) was extracted and descriptively analyzed. Results A total of 12 children with DIHS caused by vancomycin were enrolled in the study, including 10 males and 2 females. Their ages ranged from 22 months to 17 years, with a median age of 14 years. The median time from vancomycin exposure to occurrence of DIHS was 17 days, ranging from 5 to 35 days. The main clinical features were fever (12 patients, 100.0%), rash (12 patients, 100.0%), lymphadenopathy (8 patients, 66.7%), and mucosal injury (5 patients, 41.7%). Among the 12 children, 9 (75.0%) had liver injury, 4 (33.3%) had kidney injury, 2 (16.7%) had lung injury, 1 (8.3%) had spleen injury, and 1 (8.3%) had myocardial injury. Blood routine examination showed increased eosino- philia in the 11 children (91.7%) and increased atypical lymphocytosis in 5 children (41.7%). After the diagnosis of DIHS, vancomycin was discon-tinued in all the 12 children. After treatments with glucocorticoids, antihistamines, gammaglobulins, etc. (1 patient underwent liver transplantation), 11 children (91.7%) were improved and 1 (8.3%) died. Conclusions The clinical manifestations of DIHS caused by vancomycin in children are typical, mainly manifested by fever, rash, lymphadenopathy, etc. The damaged organs are mainly the liver, followed by the kidneys. Most of the children have a good prognosis, and a few may have severe organ damage leading to death.
  • Liu Yiqi, Zhu Liqin, Yang Wenjie
    Abstract ( ) PDF ( )
    Objective To explore the clinical characteristics of daptomycin-associated eosinophilic pneumonia (EP). Methods The PubMed, Web of Science, Embase, SpringerLink, Wiley Online Library, ScienceDirect databases were searched (up to 31 May 2020). Case reports of daptomycin- associated EP were collected. The patient′s general situation, daily dose of daptomycin, time of EP occurrence, clinical manifestations, auxiliary examination, and the treatment and outcome were recorded into a self-designed Excel data sheet. The clinical characteristics of daptomycin-associated EP were analyzed by descriptive statistical method. Results A total of 31 articles of case reports were collected, reporting on 43 patients with daptomycin-associated EP. The 43 patients includeed 36 males (83.7%) and 7 females (16.3%). the patients′ ages ranged from 28 to 89 years, of which 34 (79.1%) were ≥60 years old and 37 (86.0%) were suffering from diseases such as acute and chronic kidney disease, cardiovascular disease, diabetes, and etc. The daily dose of daptomycin in 6 patients exceeded the recommended dose in the drug instruction. The time from application of daptomycin to onset of EP was 4 hours to 8 weeks, and 37 (86.0%) of them were less than or equal to 4 weeks. The main clinical manifestations were fever (97.7%, 42/43) and dyspnea and hypoxemia (81.4%, 35/43), and cough (51.2%, 22/43), and artificial assisted ventilation was used in 30.2% (13/43) of patients due to respiratory failure. Forty-three patients had new invasive lesions in the lungs on chest imaging. Forty patients described peripheral blood eosinophil test results, and 39 (97.5%) had increased eosinophil proportion and/or count. Bronchoalveolar lavage fluid was performed in 27 patients and 17 (63.0%) had eosinophils >5%. After the diagnosis of EP, all 43 patients stopped using daptomycin. and received symptomatic treatments including oxygen inhalation, artificial assisted ventilation, defervescence, and cough suppression. Of them, 29 patients received glucocorticoid therapy. All the patients′ symptoms were improved significantly within 1-2 weeks and chest imaging returned to normal within 1-3 months. Conclusions Daptomycin-associated EP mostly occurred within 4 weeks of treatment, mostly in elderly and male patients. Although the symptoms were severe, the prognosis was good when the drug was stopped in time.
  • Wang Mengmeng, Zhang Yanni, Wu Aixin
    Abstract ( ) PDF ( )
    Objective To explore the occurrence and clinical characteristics of leukopenia induced by amoxicillin sodium and clavulanate potassium for injection in patients with acute pyelonephritis. Methods The subjects were patients with acute pyelonephritis who used amoxicillin sodium clavulanate potassium for injection during hospitalization in the Department of Nephrology, the University of Hong Kong-Shenzhen Hospital from January to December 2019 and had a white blood cell count (WBC) ≥4.0×109/L before amoxicillin sodium clavulanate potassium for injection administration. Cases of leucopenia caused by amoxicillin sodium clavulanate potassium for injection were collected and the patients′ basic information, duration of treatment with amoxicillin sodium clavulanate potassium for injection, concomitant medications, blood cell count before and after administration, leukopenia occurrence, and interventions and outcomes of leukopenia were extracted from electronic medical records. The incidence of leucopenia was calculated and the clinical characteristics of the adverse reaction were analyzed. Leukopenia was defined as WBC <4.0×109/L (lower limit of WBC reference value in our hospital). Results A total of 134 patients were included in the analysis. Of them, 12 developed leukopenia, the incidence was 9.0%. Among the 12 patients, 1 (8.3%) was male and 11 (91.7%) were female with an age of (35±12) years. The time from drug administration to the onset of leukopenia ranged from 2 to 6 days and it was 3 days in 6 patients (50.0%). The WBC, neutrophil count, and neutrophil proportion were (4.7~17.5)×109/L, (3.1~15.4)×109/L, and (0.60~0.90) before drug administration, and then decreased to (2.3~3.9)×109/L, (0.8~2.4)×109/L, and (0.35~0.65) after drug adminis- tration, respectively. Fifty percent (6/12) of the patients had hemoglobin decrease >20-g/L and (or) erythrocyte count decrease >0.5×1012/L. None of the 12 patients had obvious clinical symptoms, and no other interventions were given after discontinuation of the drug. WBC returned to normal in 11 patients and was unknown in the other 1 patient because the patient was lost to follow-up on day 2 of drug discontinuation after discharge. Conclusions Amoxicillin sodium clavulanate potassium for injection can cause leukopenia in patients with acute pyelonephritis, which mostly occurs within 6 days of medication. It is generally asymptomatic and can recover after drug discontinuation. The prognosis is good.
  • Sun Libo, Song Yanqing, Hu Xue, Li Yanjiao
    Abstract ( ) PDF ( )
    Objective To analyze the clinical characteristics of novel oral anticoagulants (NOAC)-related leukocytoclastic vasculitis (LCV). Methods PubMed, Embase, ScienceDirect, Ovid, and Scopus databases were searched as of August 2020 and case reports on NOAC-related LCV were collected. Relevant information in patients including gender, age, primary disease, co-existing disease, NOAC application, combined medication, LCV occurrence, treatment and outcome of LCV, and etc. was extracted and analyzed using descriptive statistical method. Results A total of 13 patients were collected; 6 were from the United States, 2 from Turkey, 2 from Spain, and 3 from Greece, South Korea, and Denmark, respectively. There were 8 males and 5 females, aged 29 to 95 years, and 9 patients were ≥60 years old.   Apixaban was applied in 5 patients, rivaroxaban in 5 patients, and dabigatran etexilate in 3 patients. Dose of NOAC was recorded in 7 patients, all of which were within the recommended range of the instructions. Time from taking NOAC to the occurrence of LCV was recorded in 12 patients, ranging from 3-18 days (7-10 days in 7 patients) after the first medication. All 13 patients developed skin lesions, presenting as purpura and/or rash. Skin lesions involved limbs and trunk in 4 patients, lower limbs in 7 patients, lower limbs and trunk in 1 patient, and upper limbs and trunk in 1 patient. Twelve patients underwent skin biopsy at the lesion site; 11 patients had neutrophil infiltration and 1 had only eosinophil infiltration. NOAC was stopped in all the 13 patients after diagnosis of LCV. Among them, other anticoagulants were switched in 12 patients and glucocorticoids were given in 9 patients. Finally, 8 were cured and 5 were improved. Conclusions NOAC-related LCV usually occurred 7-10 days after the first medication, mainly manifested as purpura and rash and often involved the lower extremities. The prognosis was good after drug withdrawal and appropriate application of glucocorticoid according to patient conditions.
  • Zhang Wen, Wang Xusheng, Liu Yunxia, Lu Cuicui
    Abstract ( ) PDF ( )
    Immune checkpoint inhibitors (ICIs)-associated immune-mediated hepatitis (IMH) is a special type of drug-induced liver injury. The risk factors of IMH include combination of different types of ICIs, comorbidities, fever, etc. Most patients with IMH are asymptomatic, but laboratory tests show mainly abnormal levels of serum transaminase. It is crucial for patients with IMH to stop or delay the use of ICIs and receive immunosuppressive therapy. The immunosuppressive therapy for IMH usually includes glucocorticoids, and the immunosuppressive agents such as tacrolimus, mycophenolate mofetil, etc. can also be added.
  • Chen Wenwen, Jiang Yongxian, Tao Wanjun, Yangjia, Li Gen
    Abstract ( ) PDF ( )
    A 4-month and 19-day-old girl with a body weight of 4.4-kg was treated with 5% digoxin oral solution 0.9-ml (0.045-mg) once per 12-hours after repair of ventricular septal and atrial septal defects. Spironolactone, hydrochlorothiazide, and captopril were given at the same time. The blood concentration of digoxin was detected on the 6th day of medication, and the pharmacist found that it was more than 5.0-μg/L, and immediately went to the ward to see the child. The bedside electrocardiograph showed that the baby girl had reduced heart rate (80 beats/min), arrhythmia, third-degree atrioventricular block, complete right bundle- branch block, and ST-T changes. Digoxin poisoning was diagnosed and digoxin was immediately discon- tinued. Three days later, the blood concentration of digoxin decreased to 1.66-μg/L, and her heart rate and electrocardiograph returned to normal. By reviewing the medication information of the baby, a digoxin poisoning event due to overdose of digoxin and drug interactions was diagnosed. Due to the event, the use of digoxin in hospitalized children in the whole hospital from January 2017 to May 2019 was investigated. Among 323 children, 14 children (4.3%) overdosed with digoxin; 235 children (72.8%) were treated with digoxin for more than 5 days, but the detection rate of blood concentration was only 12.8% (30/235); 67.5% children (240/323) were prescribed drugs that might interact with digoxin or increase the risk in digoxin treatment. Through the analysis of risk factors, improvement measures such as optimizing medical order audit system, increasing the monitoring rate of digoxin blood concentration, and strengthening training were put forward, and an expert consensus in the hospital was reached. After implementation of the improvement measures, a total of 47 children were prescribed digoxin in the whole hospital from January to June, 2020, none of them were given overdose of digoxin, and the monitoring rate of digoxin blood concentration was increased to 40.4% (19/47).
  • Ji Chunmei, Huang Wen, Hu Yunzhen
    Abstract ( ) PDF ( )
    A 32-year-old male patient received moxifloxacin hydrochloride 400-mg orally once daily for lung infection. Four days after medication, the patient developed dizziness, blurred vision, diplopia, etc. Head CT showed no abnormalities. These symptoms were considered to be related to moxifloxacin hydrochloride and the drug was discontinued. Three days later, his symptoms were not improved. Eye examination showed his pupils are equal, round, and sensitive to light; his left eyeball had abduction disorder and right eyeball had normal movement function. The patient had no facial paralysis or muscle abnormalities. Cranial magnetic resonance imaging and other auxiliary examinations showed no obvious abnormalities. Neurotrophic drugs such as mecobalamin, mouse nerve growth factor, and fursultiamine were given, and the patient′s symptoms were gradually improved. After 25 days of drug withdrawal, the patient′s symptoms completely disappeared.
  • Liu Jiancheng, Ma Xin, Chen Zhesi, Ling Zesha, Wang Wenchun
    Abstract ( ) PDF ( )
    A 79-year-old male patient was given an IV infusion of piperacillin sodium and tazobactam sodium 4.5 g once every 8 hours for head injury complicated by Escherichia coli pneumonia. Before the treatment, his white blood cell count (WBC) was 10.20×109/L, red blood cell count (RBC) was 3.58×1012/L, hemoglobin (HB) was 101-g/L, and platelet count (PLT) was 202×109/L. On day 2 of medication, his blood cell count began to decrease, with the lowest values of WBC 2.96×109/L, RBC 2.40×1012/L, Hb 66-g/L, and PLT 128×109/L, respectively. It was misdiagnosed as gastrointestinal bleeding because of positive occult blood in gastric juice of the patient at the same time. However, the patient had no obvious melena, his gastric fluid occult blood did not match the development of anemia, and there was no evidence of hemolysis or hemorrhage at other sites. The relationship between the blood cell count decrease and piperacillin sodium and tazobactam sodium was considered. The drug was discontinued and the patient′s blood cell count returned to levels before treatment 3 days later.
  • Wang Rui, Song Yanqing, Mao Lichao, Wang Xiangfeng
    Abstract ( ) PDF ( )
    A 17-month-old female infant received combination chemotherapy with cisplatin, etoposide, and bleomycin (IV infusion of cisplatin 8.5-mg on day 1 to 5, IV infusion of etoposide 42-mg on day 1 to 5, IV infusion of bleomycin 6 units on day 1) after yolk sac tumor resection. Two weeks after finishing the chemotherapy, the child developed hearing loss. Her hearing thresholds evaluation showed 32 decibel for the left ear and 45 decibel for the right ear. Two women in her mother′s family were known to be with acquired deafness by questioning the family history. The results of deafness gene screening showed that the child was a carrier of the mitochondrion 12SrRNA gene m.1555A>G site homogeneous mutation, so it was considered that the hearing loss of the child was related to her deafness susceptibility gene and ototoxicity of cisplatin.
  • Wu Shujuan, Gu Ermin, Ye Xiaolan
    Abstract ( ) PDF ( )
    A 58-year-old male patient received quadruple therapy with amoxicillin 1 g, furazo- lidone 0.1 g, rabeprazole 20-mg, and bismuth potassium citrate 0.6 g twice daily for Helicobacter pylori infection for 4 weeks. Seven days after drug withdrawal, the laboratory tests showed serum creatinine (Scr) 469-μmol/L and blood urea nitrogen (BUN) 19.2-mmol/L. Renal biopsy showed acute tubular injury. The Scr level was 78-μmol/L in the physical examination of 6 months ago. Acute kidney injury was considered to be associated with the quadruple therapy. Methylprednisolone, rebamipide, and calcium carbonate were given orally. Four weeks later, the laboratory tests showed Scr 171-μmol/L and BUN 14.4-mmol/L and the above treatments were continued; 12 weeks later, his Scr was 140-μmol/L and BUN was 11.4-mmol/L.
  • Ren Yuanqin, Zhang Lin, Chen Juanjuan, Chu Wenjiao, Wang Chen, Cai Mingzhi
    Abstract ( ) PDF ( )
    A 25-year-old female patient took Congrong Tongbian oral liquid 20-ml once daily by herself for constipation. After 3 months of intermittent medication, the patient gradually developed dark urine and yellowish skin and sclera, accompanied by nausea, vomiting, and decreased appetite; 4 months later, laboratory tests showed alanine aminotransferase (ALT) 1-359-U/L, aspartate aminotransferase (AST) 859-U/L, alkaline phosphatase (ALP) 160-U/L, total bilirubin (TBil) 131.5-μmol/L, and direct bilirubin (DBil) 99.3-μmol/L. Liver injury caused by Congrong Tongbian oral liquid was considered, then the drug was discontinued, and IV infusions of magnesium isoglycyrrhizinate injection 200-mg dissolved in 5% glucose injection 250-ml once daily and polyene phosphatidylcholine injection 20-ml dissolved in 5% glucose injection 250-ml once daily were given. After the above treatments, the patient′s symptoms were gradually improved. Two weeks later, the patient′s urine color was basically normal, gastrointestinal symptoms disappeared, and liver function showed ALT 137-U/L, AST 87-U/L, ALP 126-U/L, and TBil 34.9-μmol/L. At a 2-month follow-up, the patient′s liver function returned to normal. The patient′s liver injury was most likely related to the Polygonum multiflorum in Congrong Tongbian oral liquid.
  • Qiu Yanlong, Guan Haifang
    Abstract ( ) PDF ( )
    A 2-year-old boy with hydrocele of spermatic cord received an IV infusion of ketorolac tromethamine injection 7-mg after laparoscopic high ligation of bilateral sheath to relieve pain. About 17-hours after the medication, the boy developed gross hematuria. Ultrasonic examination showed blood clots in the bladder. Routine urine analysis showed urine occult blood (++), red blood cells >50 cells per high-power field in urine microscopy, and protein (+++). The boy did not use other drugs in the same period, and hematuria related to ketorolac tromethamine injection was considered. The boy received IV infusions of etamsylate injection 0.5 g once daily and then ceftriaxone sodium for injection 0.5 g once daily successively. After 6 days of treatments, the boy′s gross hematuria disappeared. Routine urine analysis showed urine occult blood (+++), 3 red blood cells per high-power field in urine microscopy, and urine protein (+++). Eleven days later, the re-analysis showed urine occult blood (+), none red blood cell per high-power field in urine microscopy, and urine protein (++). One month later, the re-analysis showed urine occult blood (-) and urine protein (-).
  • Sun Zhenxiao, Yu Xiangfen
    Abstract ( ) PDF ( )
    A 61-year-old female patient with depressive disorder was prescribed paroxetine hydrochloride 20-mg orally once each morning, but the patient took the drug thrice daily by mistake. On the 6th day of medication, the patient suddenly fell down. She was unconscious accompanied by limb convulsion, presenting as epileptic attack. Electroencephalogram (EEG) showed a moderate abnormality. The patient had no previous history or family history of epilepsy, the cause of the seizures was considered to be overdose of paroxetine hydrochloride. The drug was taken correctly as prescribed by doctor and magnesium valproate sustained release tablets 0.25 g orally twice daily were added. The patient did not have any further epileptic attack and the EEG recovered to normal.
  • Gu Huan, Jiang Huadong
    Abstract ( ) PDF ( )
    A 49-year-old male patient with stage IV lung adenocarcinoma received IV infusions of pemetrexed disodium 0.8 g dissolved in 0.9% sodium chloride injection 100-ml on the 1st day and cisplatin 30-mg dissolved in 0.9% sodium chloride injection 250-ml in the first 4 days (each treatment cycle was 21 days). At the same time, he received targeted therapy with gefitinib 250-mg orally once daily. On the 10th day of drug withdrawal in the third chemotherapy cycle, the 59th day of gefitinib administration, the patient developed dizziness and decreased vision. The ophthalmic examination showed retinal hemorrhage and elevated intraocular pressure, which were considered to be related to gefitinib. Because of the patient′s condition, the original treatments were continued, and the treatments of reducing intraocular pressure and restoring vision were given at the same time. On the 4th day of the continuation of original treatments, his dizziness was slightly improved, but the visual was not. On the 10th day, his vision did not recover. After that, the patient was lost to follow-up.