- 著者
- 渡辺 裕之 中村 和行 石川 歩未 李 振雨 足立 康則 鍋島 俊隆 杉浦 洋二
- 出版者
- 日本緩和医療学会
- 雑誌
- Palliative Care Research (ISSN:18805302)
- 巻号頁・発行日
- vol.16, no.2, pp.133-138, 2021 (Released:2021-04-22)
- 参考文献数
- 28
【緒言】糖尿病を合併した終末期悪性リンパ腫患者の経口投与が困難な難治性悪心に対して,アセナピン舌下錠を使用し,悪心の改善ができたので報告する.【症例】78歳男性,糖尿病を併発するびまん性大細胞型B細胞リンパ腫の患者で右前頭葉,小脳に腫瘤や結節,周囲脳実質に浮腫が認められた.中枢浸潤が原因と考えられる悪心・嘔吐を繰り返し,経口投与はできなかったためメトクロプラミド,ハロペリドール,ヒドロキシジン注を併用したが,悪心のコントロールは困難であった.アセナピンは糖尿病患者にも使用可能で,制吐作用があるオランザピンと同じ多元受容体作用抗精神病薬に分類される.その作用機序から制吐作用が得られることを期待し,アセナピン舌下錠5 mg,1日1回就寝前の投与を開始した.アセナピン舌下錠の開始後,難治性悪心は著明に改善した.【考察】アセナピンは,難治性悪心に対する治療の有効な選択肢となる可能性がある.
- 著者
- 祢宜田 和正 山下 雅代 久保田 敏行 杉浦 洋二 三浦 崇則 勝見 章男 太田 満 齋竹 達郎 戸澤 良夫 水谷 勝
- 出版者
- 一般社団法人日本医療薬学会
- 雑誌
- 医療薬学 (ISSN:1346342X)
- 巻号頁・発行日
- vol.27, no.2, pp.123-131, 2001-04-10 (Released:2011-03-04)
- 参考文献数
- 17
- 被引用文献数
- 1 2
Although vancomycin has been exclusively used for methicillin-resistant Staphylococcus aureus (MRSA) therapy, there are many patients recently observed to suffer from gram negative bacteria, Pseudomonas aeruginosa as well as MRSA.Arbekacin (ABK), an aminoglycoside antibiotic (AG) is an alternative medication for such patients with those infection disease. However, it seems that the dosage of ABK used according to the manufacture's recommendations is insufficient for MRSA therapy to obtain a sufficient patient outcomes. Moreover, the relationship between the effectiveness of ABK on MRSA infection and the serum ABK concentration remains unclear. For the long-term treatment of AG, we can not rule out the possibility that AG may induce nephrotoxicity and ototoxicity.Therefore, the present study was carried out to clarify the significance of therapeutic drug monitoring (TDM) of ABK for patients with an MRSA infection, and elucidate the relationship between the serum ABK level and its clinical outcomes, including its antibacterial action and side effects. We investigated 30 patients with an MRSA infection, who received ABK at the Anjo Kosei Hospital from September 1996 to June 1998. The treatment of the patients by ABK but without TDM showed a 46.6% (7/15) therapeutic efficacy, while the patients with drug monitoring had a remarkably successful therapeutic efficacy (100% : 21/21) with a peak serum ABK concentration over 10μg/mL. Dysphagia badly affected the efficacy of ABK therapy in patients with an MRSA infection even when the serum ABK level was well-controlled. The incidence of ABK induced nephrotoxicity was observed in all patients when ABK was administered at a total dose of over 5, 000mg, while it was 4% at a total dose of less than 5, 000mg. When the duration of ABK therapy was longer than 2 weeks, the incidence of nephrotoxicity also significantly increased.These results thus suggest that TDM of ABK is useful for increasing the efficacy of ABK therapy in patients with an MRSA infection. In light of nephrotoxicity, these results indicate that ABK therapy may be completed within 2 weeks with an ABK dose of less than 5, 000mg, as the total dose.