重症肌无力合并感染的抗菌药应用进展

doi:10.19803/j.1672-8629.2019.10.11

摘要/Abstract

摘要： 重症肌无力（myasthenia gravis, MG）是一种主要累及神经肌肉接头突触后膜乙酰胆碱受体的获得性自身免疫疾病。感染是MG病情发展过程中最常见的并发症之一,然而部分抗菌药干扰神经-肌肉接头运动,可能导致MG症状加重,甚至诱发肌无力危象。因此合理选择抗菌药,对MG患者尤为重要。本文对影响MG症状的抗菌药进行了归纳总结,并对抗菌药的选择提出了推荐意见,以期对临床医师运用抗菌药及新型药物研发提供参考信息。

关键词: 重症肌无力, 感染, 神经肌肉阻滞, 抗菌药

Abstract: Myasthenia gravis( MG ) is an acquired autoimmune disease that primarily affects the postsynaptic membrane acetylcholine receptors of neuromuscular junctions. Infection is one of the most common complications in the development of MG. However, some antibacterial drugs interfere with the movement of nerve-muscle joints, which may aggravate the symptoms of MG and even induce myasthenic crisis. Therefore, cautious selection of antibacterial drugs is particularly important for MG patients. This paper summarizes the antibacterial drugs that affect the symptoms of MG, and raise recommendations for the selection of antibacterial drugs in order to provide reference for clinicians to use antibacterial drugs and for new drug research and development.

Key words: myasthenia gravis, infection, neuromuscular block, antibiotics

中图分类号:

R978.1

潘纬榕, 沈娴, 孙思娴, 朱旭莹. 重症肌无力合并感染的抗菌药应用进展[J]. 中国药物警戒, 2019, 16(10): 625-631.

PAN Weirong, SHEN Xian, SUN Sixian, ZHU Xuying. Antibiotic Application of Myasthenia Gravis Complicated with Infection[J]. Chinese Journal of Pharmacovigilance, 2019, 16(10): 625-631.

参考文献

[1] 中国免疫学会神经免疫学分会. 重症肌无力诊断和治疗中国专家共识[J]. 中国神经免疫学和神经病学杂志, 2012,6(19):401-408.
[2] 韩曙光,吕蕾,赵弘卿,等. 重症肌无力患者并发呼吸衰竭的影响因素及其预后相关因素研究[J]. 实用心脑肺血管病杂志,2015,23(10):32-35.
[3] Van Berkel M A, Twilla J D, England B S. Emergency Department Management of a Myasthenia Gravis Patient with Community- Acquired Pneumonia: Does Initial Antibiotic Choice Lead to Cure or Crisis?[J]. J Emerg Med,2016,50(2):281-285.
[4] Ramos-Fransi A, Rojas-Garcia R, Segovia S, et al.Myasthenia gravis: descriptive analysis of life-threatening events in a recent nationwide registry[J]. Eur J Neurol, 2015,22(7): 1056-1061.
[5] Gui M, Luo X, Lin J, et al.Long-term outcome of 424 childhood- onset myasthenia gravis patients[J].J Neurol,2015, 262(4):823-830.
[6] 徐仙女. 重症肌无力患者肺部感染临床分析[J]. 中华医院感染学志,2011,21(4):687-688.
[7] Gilhus N E, Romi F, Hong Y, et al.Myasthenia gravis and infectious disease[J].J Neurol,2018,265(6):1251-1258.
[8] Dhand U K.Clinical approach to the weak patient in the intensive care unit[J]. Respir Care, 2006,51(9):1024-1041.
[9] 王美霞. 氨基糖苷类药物的不良反应及综合防治对策[J]. 中国实用医药, 2016,11(2):269-270.
[10] 邓敏, 胡芳, 王云甫,等. 头孢菌素类、喹诺酮类和氨基糖苷类抗菌药物对重症肌无力影响研究[J]. 中国感染控制杂志, 2005,4(1):4-8.
[11] 张慧颖. 临床常见非合理用药[M]. 4版.北京: 人民卫生出版社, 2010:601-602.
[12] Hokkanen E.Antibiotics in myasthenia gravis[J]. Br Med J, 1964,1(5390):1111-1112.
[13] Hokkanen E.The aggravating effect of some antibiotics on the neuromuscular blockade in myasthenia gravis[J]. Acta Neurol Scand, 1964,40(4):346-352.
[14] Hussain N, Hussain F, Haque D, et al.A diagnosis of late- onset myasthenia gravis unmasked by topical antibiotics[J]. J Community Hosp Intern Med Perspect, 2018,8(4):230-232.
[15] Maramattom B V, Wijdicks E F.Acute neuromuscular weakness in the intensive care unit[J]. Crit Care Med, 2006,34(11): 2835-2841.
[16] Deng M, Wang Y F, Hu F, et al.Effect of different kinds of antibiotics on transmission function at the neuromuscular junction in mice with myasthenia gravis[J]. Chin J Clin Rehabil,2005,17(9):233-235.
[17] Sieb J P.Fluoroquinolone antibiotics block neuromuscular transmission[J]. Neurology, 1998,50(3):804-807.
[18] FDA. Risk of Fluoroquinolone-associated Myasthenia Gravis Exacerbation February 2011 Label Changes for Fluoroquinolones [EB/OL]. (2011-03-15)[2019-02-12]. https://wayback. archive-it.org/7993/20170112174719/http://www.fda.gov/ Safety/MedWatch/SafetyInformation/ucm247115.htm.
[19] 国家食品药品监督管理总局. 药物警戒快讯[EB/OL]. (2012-05-16)[2019-02-12]. http://www.cdr-adr.org.cn/ yxaqjs/gj/201205/t20120516_4990.html.
[20] 谢欢, 陈颖, 韦凤. 喹诺酮类药物诱发/加重重症肌无力个案汇总分析[J]. 中国药物应用与监测, 2018,15(1): 24-27.
[21] 林艾羽. 莫西沙星致重症肌无力患者发生肌无力危象一例报告[C]//第十一次中国中西医结合神经科学术会议论文汇编.河北:中国中西医结合学会,2015:329-330.
[22] Amitabh V, Singhal A, Kumar S, et al.Efficacy and safety of oral gemifloxacin for the empirical treatment of pneumonia[J]. Lung India, 2012,29(3):248-253.
[23] 毕煌垒, 张佳岳, 刘晓慧,等. 新型广谱氟喹诺酮类抗菌药物—德拉沙星[J]. 临床药物治疗杂志, 2017,15(7): 6-10.
[24] 苗贝贝, 梁蓓蓓, 王睿,等. 新型无氟喹诺酮类药物奈诺沙星的研究进展[J]. 中国医院用药评价与分析, 2016,16(11): 1577-1580.
[25] Absher J R, Bale J J.Aggravation of myasthenia gravis by erythromycin[J]. J Pediatr, 1991,119(1):155-156.
[26] May E F, Calvert P C.Aggravation of myasthenia gravis by erythromycin[J]. Ann Neurol, 1990,28(4):577-579.
[27] 王菲菲,于双得,王红菊.阿奇霉素致重症肌无力加重1 例[J]. 药物流行病学杂志, 2017,26(10):682.
[28] 张颖, 童庆伟. 阿奇霉素致重症肌无力危象1例[J]. 临床荟萃, 2010,17(25):1548.
[29] Ross D B.The FDA and the case of Ketek[J]. N Engl J Med, 2007,356(16):1601-1604.
[30] Bertrand D, Bertrand S, Neveu E, et al.Molecular characterization of off-target activities of telithromycin: a potential role for nicotinic acetylcholine receptors[J]. Antimicrob Agents Chemother, 2010,54(12):5399-5402.
[31] Liu C N, Somps C J.Telithromycin blocks neuromuscular transmission and inhibits nAChR currents in vitro[J]. Toxicol Lett, 2010,194(3):66-69.
[32] Van Bambeke F.Renaissance of antibiotics against difficult infections: Focus on oritavancin and new ketolides and quinolones[J]. Ann Med, 2014,46(7):512-529.
[33] Garrido-Mesa N, Zarzuelo A, Gálvez J.Minocycline: far beyond an antibiotic[J]. Br J Pharmacol, 2013,169(2):337-352.
[34] Roper J, Fleming M E, Long B, et al.Myasthenia Gravis and Crisis: Evaluation and Management in the Emergency Department[J]. J Emerg Med, 2017,53(6):843-853.
[35] 刘晓东, 谢思宁, 菅凌燕,等. 替加环素不良反应的文献计量分析[J]. 中国新药杂志, 2017,26(19):2364-2368.
[36] Argov Z, Brenner T, Abramsky O.Ampicillin may aggravate clinical and experimental myasthenia gravis[J]. Arch Neurol, 1986,43(3):255-256.
[37] Sonawalla A B, Lance J W.Relapse of myasthenia gravis after amoxycillin therapy[J].J Pak Med Assoc, 1989,39(1): 18-19.
[38] O’Riordan J, Javed M, Doherty C, et al. Worsening of myasthenia gravis on treatment with imipenem/cilastatin[J]. J Neurol Neurosurg Psychiatry, 1994,57(3):383.
[39] Jones S C, Sorbello A, Boucher R M.Fluoroquinolone- associated myasthenia gravis exacerbation: evaluation of postmarketing reports from the US FDA adverse event reporting system and a literature review[J]. Drug Saf, 2011, 34(10):839-847.
[40] 南李, 叶晓芬, 蔡映云,等. 1例重症肌无力合并咳嗽变异性哮喘及肺部感染患者的用药分析[J]. 上海医药, 2016, 37(21):63-65.
[41] Elsayed M G, Elkomy A A, Elbadawy M.Some Pharmacodynamic Aspects of Cefepime[J]. J Pharm (Cairo), 2013,2013:381910.
[42] Grill M F, Maganti R K.Neurotoxic effects associated with antibiotic use: management considerations[J]. Br J Clin Pharmacol, 2011,72(3):381-393.
[43] Nguyen C T, Nanfro J.Probable vancomycin-induced myasthenic crisis: a case report[J]. J Antimicrob Chemother, 2018,73(4):1106-1108.
[44] Pittinger C B, Eryasa Y, Adamson R.Antibiotic-induced paralysis[J]. Anesth Analg, 1970,49(3):487-501.
[45] Torres A, Zhong N, Pachl J, et al.Ceftazidime-avibactam versus meropenem in nosocomial pneumonia, including ventilator-associated pneumonia (REPROVE): a randomised, double-blind, phase 3 non-inferiority trial[J].Lancet Infect Dis, 2018,18(3):285-295.
[46] Wagenlehner F M, Umeh O, Steenbergen J, et al.Ceftolozane- tazobactam compared with levofloxacin in the treatment of complicated urinary-tract infections, including pyelonephritis: a randomised, double-blind, phase 3 trial (ASPECT-cUTI)[J].Lancet, 2015,385(9981):1949-1956.