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你对青霉素过敏吗?有些疾病往往不需要使用青霉素

发布时间:2019-11-03 20:32:32  来源:好孕妈妈社区    采编:太子阁生殖专家  

  佐治亚大学的一名研究人员正在努力纠正这种误解和公共卫生威胁。

  美国有3000多万人错误地认为自己对青霉素过敏,这导致了数百万美元的医疗费用增加,更强效抗生素的副作用增加,以及危险的抗生素耐药性感染的增加。

  这种误解和公共卫生威胁可以纠正,克里斯托弗·m .平淡说临床副教授乔治亚大学的药学院,问的人说,他们对青霉素过敏回答一个简单的单页的问卷,如果有必要,青霉素过敏测试,或者过去。

  在很多情况下,我们不必通过调查问卷。“我们发现,大多数患者认为的过敏反应其实只是一种副作用,这种副作用可能发生过一次,也可能永远不会再发生。病人告诉我们,他们多年前服用青霉素后感到头晕或恶心,或者他们的父亲对青霉素过敏,所以他们认为自己也过敏。”

  布兰德说,盘尼西林常常受到指责,但它可能不是罪魁祸首。他说,即使那些曾经对青霉素过敏的人现在也不再过敏了。五年后,研究表明,对青霉素有过敏反应(如荨麻疹、气喘、气短或过敏反应)的人中有一半不再对青霉素过敏。他说,10年后,这个数字会跃升至80%。

  “我们发现,大多数患者认为的过敏反应其实只是一种副作用,这种副作用可能发生过一次,也可能永远不会再发生。——克里斯托弗·m·布兰德

  在最近于华盛顿举行的IDWeek国际传染病会议上发表的一项研究中在佐治亚大学的药学专业学生对病人进行采访后,布兰德和他的同事展示了从病人记录中删除青霉素过敏的数量。

  布兰德说:“通过我们的问卷调查,我们可以让那些认为自己对青霉素过敏的人立刻减少20%。”“我们的药学专业学生能够通过获得详细的病史来揭穿许多病人声称的过敏史。”

  尽管美国传染病学会建议青霉素过敏评估被提升的方式来消除这个标签在医疗记录对于那些不过敏,大部分的研究,包括过去来完成这一任务已经完成在学术医疗中心由训练有素的变态。

  布兰德和圣约瑟夫/坎德勒卫生系统(St. Joseph 's /Candler Health System)传染病临床药学专家、萨凡纳佐治亚大学药学院(UGA College of pharmacy assistant professor)兼职教授布鲁斯·琼斯(Bruce Jones)表示,这是没有必要的,可以在没有专门训练有素的过敏专科医生的医院里进行。他们正在与全国50多家医院合作,分享最佳做法,使过去得以实施,并更新医疗记录。

  五年后,研究表明,对青霉素有过敏反应(如荨麻疹、气喘、气短或过敏反应)的人中有一半不再对青霉素过敏。10年后,这个数字跃升至80%。

  在一项得到资助的研究中,布兰德和琼斯发现,过去对那些认为自己对青霉素过敏的病人所做的研究表明,他们并没有真正的过敏。青霉素是目前最有效的抗生素,副作用最小。

  这些研究结果发表在《传染病公开论坛》上。他们与坎德勒医院的护士合作,发现皮肤测试可以在社区医院安全进行。当由训练有素的护士在医院进行皮肤测试时,研究中有100个病人中有98个在他们的医疗记录中有青霉素过敏,但被认为对抗生素不过敏。

  这使得大多数患者可以立即改用青霉素类抗生素,这种抗生素通常更安全、更便宜,可以改善治疗结果并减少不良反应,这也是联邦抗菌药物管理计划的目标,该计划要求医院确保只在必要时使用抗生素。

  除了对公众健康有益之外,布兰德估计,如果病人能从更昂贵的抗生素治疗转向青霉素,每年还能节省数千万美元的医疗费用。坎德勒医院的研究发现,平均每位患者可节省350美元,其中包括皮肤测试的费用。

  “我们的团队现在正在执行一项任务,”布兰德说。“我们的目标是对每一种青霉素过敏进行调查和调解,大多数都要从医疗记录中删除,让患者获得针对其特定感染的最佳抗生素,通常是青霉素。”
 

  A University of Georgia researcher is working to correct this misconception and public health threat.

  More than 30 million people in the United States wrongly believe they are allergic to penicillin – resulting in millions of dollars in added health care costs, adverse side effects from the use of more powerful antibiotics and a risk in the rise of dangerous antibiotic resistant infections.

  This misconception and public health threat could be corrected, said Christopher M. Bland, clinical associate professor at the University of Georgia College of Pharmacy, by asking those who say they are allergic to penicillin to answer a simple one-page questionnaire and, if necessary, take a penicillin allergy skin test, or PAST.

  In many instances we don’t have to go past the questionnaire,” Bland said. “We’re finding out that what most of these patients think is an allergic reaction is really only a side effect that may have happened once and might never happen again. Patients tell us that they became dizzy or nauseated after taking penicillin years ago or that their father was allergic to penicillin, so they thought they were allergic as well.”

  Bland said penicillin often gets blamed when it may not be the culprit. Even those who may have once been allergic to penicillin are no longer allergic today, he said. After five years, studies show that half of the individuals who had an allergic reaction – like hives, wheezing, shortness of breath or anaphylaxis – to penicillin were no longer allergic. At 10 years, that number jumps to 80 percent, he said.

  “We’re finding out that what most of these patients think is an allergic reaction is really only a side effect that may have happened once and might never happen again.” — Christopher M. Bland

  In research presented recently at IDWeek, the international infectious diseases meeting in Washington, D.C., Bland and colleagues demonstrated how many penicillin allergies were removed from patient records after patients were interviewed by UGA pharmacy students.

  “We are able to reduce the number of those who think they have penicillin allergy by 20 percent right away, just by talking to them through our questionnaire,” said Bland. “Our pharmacy students were able to debunk the allergy claim by many patients just by getting a detailed history.”

  While the Infectious Diseases Society of America has recommended that penicillin allergy assessment be promoted as a way to erase this label on medical records for those who are not allergic, most of the studies that have included PAST as a way to accomplish this have been done at academic medical centers by trained allergists.

  Bland and Bruce Jones, an infectious diseases clinical pharmacy specialist at St. Joseph’s/Candler Health System and adjunct UGA College of Pharmacy assistant professor in Savannah, said this isn’t necessary and can be done in hospitals that do not have dedicated trained allergists on staff. They are working with more than 50 hospitals throughout the country, sharing best practices that will allow PAST to be performed and medical records updated.

  After five years, studies show that half of the individuals who had an allergic reaction – like hives, wheezing, shortness of breath or anaphylaxis – to penicillin were no longer allergic. At 10 years, that number jumps to 80 percent.

  In a grant-funded study, Bland and Jones found that PAST done on patients who believed that they were allergic to penicillin – the most effective antibiotic available with the least side effects – demonstrated no real allergy.

  These research findings were published in Open Forum Infectious Diseases. The duo worked with nurses at Candler Hospital and found that skin testing can be done safely in a community hospital setting. When skin testing was performed at the hospital by trained nurses, 98 out of 100 patients in the study who had a penicillin allergy on their medical record were deemed not be allergic to the antibiotic.

  This allowed for an immediate change to a penicillin type antibiotic for most patients, which is often safer and cheaper, improves outcomes and reduces adverse effects, the goal of the federal antimicrobial stewardship program requiring hospitals to ensure that antibiotics are used only when necessary.

  In addition to the public health benefit, Bland estimated that health care savings would be in the tens of millions of dollars annually if patients could be switched back to penicillin from more costly antibiotic treatments. The study at Candler Hospital found an average cost savings of $350 a patient, which includes the cost of the skin test.

  “Our team is on a mission right now,” said Bland. “Our goal is that every penicillin allergy is questioned and reconciled, with most coming off medical records and allowing patients to get the best antibiotic for their particular infection, which is often a penicillin.”

  声明:本文仅为传递更多网络信息,不代表马来西亚太子阁医药中心|官网|医院|生殖中心观点和意见,仅供参考了解,更不能作为投资使用依据。


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