The 85-year-old wang tai, who had been admitted to a hospital in beijing because of asthma, was given a sodium sulphate (rosphen) for infusion without a leather test. Unexpectedly, the elderly had an allergic reaction half a minute after the infusion, their breathing heart stopped and later died that month after rescue. After the incident, the children of the elderly brought the hospital to court for compensation. The court of first instance decided that the hospital had 30 per cent responsibility. In recent days, the sentence was upheld in the final court of the beijing second central court。
There have been occasional cases in which a patient's allergy has been caused by antibacterial antibacterial drugs, and is it necessary for many hospitals, in order to ensure the patient's safety and avoid medical disputes, to opt for a skin test for all patients who have injected intravenous antibacterial drugs? How to make scientific decisions
There's no statute that specifically requires a test
Antibacterial antibacterials such as capisculin are β-neamide antibacterials with head acne in a class of molecules. The number of adverse reactions reported was the highest because of the fact that the use of drugs such as botulinum in the country's clinical use was very large in absolute terms, but the rate of adverse reaction was low. Globally, the number of injecting drug use per year is hundreds of millions, but the prevalence of allergies is only 0. 001 per cent to 0. 1 per cent, not higher than many commonly used antibacterial drugs, such as the aqualone and the large meths. Heading drugs have a history of clinical application for more than 30 years, and there have been few cases of serious adverse effects such as sensitive shock, and death cases have been reported only on a case-by-case basis。
Our policy requirements are not uniform with regard to the practicability of anti-bacterial drugs for saplings. It is stated in the textbook basic care sciences that skin allergies should be tested prior to the use of sepsis and that a re-testing should be done after the batch number or plant has been replaced。
The pharmacy of the people's republic of china (2010 edition) and the guidelines for clinical application of antibacterial medicines provide that: head sapps shall be used on a case-by-case basis for persons who are allergic to penicillin; they shall be prohibited for any patient with an allergy and an allergy history of penicillin; they shall be preceded by a detailed inquiry as to whether the patient has previously had an allergy history of herbicides, penicillin or other drugs, and patients with an allergy history of penicillin, other β-nimamines and other drugs shall be treated with caution and caution in the application of the instructions; and they shall be discontinued as soon as a sensitive reaction occurs in the course of their use. In case of a sensitization shock, immediate and immediate rescue and related treatment such as adrenaline. It is clear that there is no explicit requirement for a physical examination。
The national prescription collection of china (2010 edition) recommends that the conduct of the test be determined in accordance with the medical instructions. In the capricorn medicines note, only the "dermal allergy test prior to the drug is appropriate" requirement, while the rest of the drugs only indicate "prudence for penicillin allergies" and do not explicitly require a leather test。
Not only my country, but also foreign regulations. Both the european society of perversion and clinical immunology recommended the need for a pixel test of antibacterials with a herbicide. The united states institute for allergies, asthma and immunology, among others, has developed “guidelines for the implementation of allergy-response diagnosis and management” that for antibacterial drugs other than penicillin, the clinical relevance of the results of the pico-test may be uncertain in the absence of a standard cortex test and therefore no routine deaperture is required. The same applies to japan。
Not only is the policy inconsistent with the need for a leather test, but there is also a lack of clarity on the selection, concentration, formulation and operation of the leather test。
There are many reasons for allergies
1. The allergies of the peptide drug are associated not only with the beta-neamide ring, but also with the side chain on the peptoxin. Allergies to penicillin are not necessarily allergies to head scabies. Only the r1-side chain of penicillin and capisculin-like antibacterials may have cross-reactions when they have similar structures, such as thorium, thorium, thorium, and second-generation septum. In contrast, third- and fourth-generation hemorrhoids are rarely allergic to penicillin because of the structure of the r1-side chain. In the case of ige-induced penicillin allergies, the use of penicillin should be avoided while the use of first- and second-generation septococin is avoided, while third- and fourth-generation sepsis is not so restricted. There is also a lack of full cross-sensitivity between the various types of drug of a herbicides due to the different side chains。
2. The occurrence of an allergy is closely related to the patient's allergy。
3. The amount of impurities and their polymers mixed in the production process. As a result, the sensitivity of different varieties, different specifications, different manufacturers, and different batches of cappulsin-type drugs cannot be identical. The fewer polymer impurities, the more pure the quality of the drug, the lower the allergies。
As a result, the beijing institute of medicine antibiotics professional committee, in the expert consensus of the high-level forum for the experimentation of antibacterial pipes with hair spires, stated: if skin allergies are tested for head spasm antibacterial drugs, the original drug must be used to make a leather test, not to replace it with a penicillin test, or to make all headbacteric antibacterial drugs. Studies have shown that, in comparison with sodium prisms, primordial piping can significantly reduce the incidence of piping negatives for drug-like piping. The original liquid was commonly used at concentrations of 300 mg ~ 500 mg/ml and was diluted with physico-saline water with a injection of 0. 1 ml。
Balancing the trade-offs against the trend towards the elimination of prisms
Synthesis of available research evidence:
1. Because of the current inconsistent approach to the pictorial examination of antibacterials of saplings, it is often not possible to reflect the real situation of patients。
2. More research evidence than that suggests that the sensitivity and positive prognosis of generic antibacterial tests of the herbicide type is too low to effectively predict rapid hair allergy. This is also in line with the trend of foreign multinational policies to eliminate the requirement of a test。
3. The inability to effectively test allergies in the leather test results in a larger number of patients receiving false positive results relative to the actual allergies, thus losing opportunities for treatment。
4. The process of the prism is also a trigger for an allergic reaction to the human body and a lesser risk to the patient。
5. The prevalence of allergies of antibacterials of the sap is extremely low and is a more secure type of drug. Even if not, the prevalence of allergies will not increase significantly。
6. The configuration of the leachate is likely to increase the consumption of an original liquid, and the sensitivity of different varieties, different specifications, different manufacturers and different batches of drugs will require re-testing, increasing medical costs。
Detailed inquiries into the history of the disease, early detection of allergies and, if found, immediate measures are more important than a test。
