Late-onset adverse reactions refer to allergic reactions that occur when the body is stimulated by the drug after 12 hours of medication, which is mediated by cells, and T cells are one of the main factors. Clinical adverse reactions generally refer to the failure to achieve the effect of medication and to bring discomfort and pain to patients. At present, the more commonly used clinical cephalosporin and penicillin have strong antibacterial properties, which are commonly used in the treatment of children, but the incidence of adverse reactions is high, and in severe cases, even death will occur. Adverse reactions of penicillins and cephalosporins mainly include:
( 1) Allergic reactions: allergic reactions are more common in the clinic, their incidence accounts for 5% to 10% of the total number of adverse reactions, patients will mainly have asthma, fever, rash and other symptoms, severe cases will even cause patients to shock or death, in the incidence of allergic reactions, the third generation of cephalosporins ranked first, cefotaxime drugs Anaphylactic reaction incidence rate of 1.8%, the incidence of anaphylactic shock symptoms was 13.2%; the incidence of allergic reactions of ceftriaxone drugs was 1.3%, The incidence of symptoms of anaphylactic shock is 11.4%, the incidence of cefoperazone allergic reactions is 2.2%, and the incidence of symptoms of anaphylactic shock is 17.8%.
( 2) Urinary system adverse reactions: penicillins and cephalosporin drugs have different degrees of toxicity to the kidneys, because most of the metabolism of the agent is excreted by the kidneys, cefazolin, cefalexin and cefaladine excreted in one day by 80% ~ 90%, excreted cefoperazone is 50% ~ 61%, causing damage to the renal tubules, resulting in necrosis, urinary blood symptoms, if the patient's kidney dysfunction, it will make the drug accumulate in the body, aggravating the disease.
(3) Nervous system adverse reactions: In patients using penicillins and cephalosporin drugs, 2% of patients will have abnormal reactions such as pain and dizziness, under normal circumstances, the conventional dose cannot cross the blood-cerebrospinal fluid barrier, but when the dose is increased, it will lead to psychotoxic reactions, and when the dose of ceftriaxone is used, it will cause choroid plexus allergies and seriously affect the central nervous system. Delayed adverse reactions not only threaten the life and health of children, make parents of children have negative emotions of worry, and are prone to disputes with hospitals, especially delayed adverse reactions are often ignored, which will seriously affect the treatment effect and medication safety. The objective of this study was to analyze the adverse reactions of pediatric penicillins and cephalosporins in the 970th Hospital of the Chinese People's Liberation Army.
The results are as follows:
1 Types and dosage forms of drugs
Among the 64 children with late-onset adverse reactions, 28 children with late-onset adverse reaction symptoms due to the use of penicillin drugs, accounting for 43.75%; 36 children with late-onset adverse reaction symptoms due to the use of cephalosporins, accounting for 56.25%; among them, 8 children with late-onset adverse reactions due to oral drugs, accounting for 12.50%; 56 children with late-onset adverse reactions due to injection drugs, accounting for 87.50%.
2 Delayed type adverse reactions occur time distribution
There were 36 children with late-onset adverse reactions after 12 hours of medication, accounting for 56.25%, 25 children with late-onset adverse reactions after 13 to 24 hours of medication, accounting for 39.06%, and 3 children with late-onset adverse reactions 25 to 36 hours after medication, accounting for 4.68%, and the time of delayed adverse reactions in children was mainly distributed 12 hours after medication.
3 Symptoms of late-onset adverse reactions
The main symptoms of 64 children were 17 cases( accounting for 26.56%; vomiting 8 cases, accounting for 12.50%; rash 39 cases, accounting for 60.94%. The delayed adverse reactions in children are mainly rashes.
discuss
Allergic reactions caused by penicillins and cephalosporins, the mechanism of occurrence is on sensitized cells, antigens and antibodies in the interaction, cephalosporins and penicillin drugs themselves do not contain antigenicity, but in penicillin preparations, there are penicillin degradation production, polymer polymers, etc., cephalosporin preparations contain polymers and other substances, can be used as a haptenic identity into the body, combined with dopamine or protein, forming a complete antigen, resulting in T lymphocyte sensitization, stimulation B Lymphocyte differentiation proliferation, the formation of ige-specific antibodies, and will adhere to the blood of basophils and more masted cell surface, so that the patient's body into a sensitized state, when the patient receives an antigen stimulation, there will be a combination of specific ige and antigen, so that the cell rupture, and release a large number of histamine, serotonin, slow-reacting substances, bradykinin and other vasoactive substances, so that microvascular dilation, smooth muscle contraction, glandular secretion increased, capillary permeability increased, This results in a series of allergic symptoms in the patient .
The results of this study show that there were 28 (43.75%) children with late-onset adverse reaction symptoms due to the use of penicillin drugs, 36 cases (56.25%) with late-onset adverse reaction symptoms due to the use of cephalosporins, 8 children with late-onset adverse reactions due to oral agents (12.50%), and 56 children with late-onset adverse reactions due to injection drugs (87.5%). There were 35 cases (54.68%) of children with 12 hours of medication, 23 cases (35.94%) of children with 13 to 24 hours of medication, and 2 cases (3.13%) of children with medication for 25 to 36 hours; the main symptoms of late-onset adverse reactions in children were diarrhea, vomiting and rash.
In order to reduce the adverse reactions caused by penicillin and cephalosporin drugs, it is necessary to carefully ask the parents of the child before taking the drug, whether the child has a history of allergies to penicillin and cephalosporin drugs, whether the child's constitution is an allergic type, whether the same kind of drug has been used in the past, and the correct drug skin test should be done on the child, the cephalosporin agent can choose the original solution, try to choose the oral agent when choosing the type of agent, even if the oral agent should be tested before taking the drug, Doctors and parents for the choice of children's medication as far as possible to avoid combination of drugs, to prevent the incidence of delayed adverse reactions increased, and after the occurrence of delayed adverse reactions is difficult to determine the accurate cause, delay in treatment, after the child's intravenous infusion needs to observe the child for more than 30 minutes, to ensure that the child can leave after no discomfort occurs, in the 12 h after the ivy infusion should increase the observation of the child, timely treatment of the child's discomfort symptoms, after stopping the drug, take the initiative to ask the doctor whether to continue to take the drug.
In summary, children with negative skin tests of penicillins and cephalosporins still have adverse reactions after 12 hours of medication, and need to be observed after the child is used to prevent delayed adverse reactions in children.