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Clinical features, diagnosis and management of amoxicillin-induced Kounis syndrome
Frontiers in Pharmacology ( IF 5.6 ) Pub Date : 2022-10-31 , DOI: 10.3389/fphar.2022.998239
Chunjiang Wang 1 , Yulu Zhou 2 , Weijin Fang 1 , Zuojun Li 1 , Shaoli Zhao 3
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Background: The available evidence suggests that amoxicillin is often associated with the occurrence of Kounis syndrome (KS). The purpose of this study is to explore the clinical characteristics of KS induced by amoxicillin.Methods: We searched for case reports of amoxicillin-induced KS through Chinese and English databases from 1972 to May 2022.Results: A total of 33 patients with KS were included, including 16 patients (48.5%) receiving amoxicillin treatment and 17 patients (51.5%) receiving amoxicillin-clavulanate. The median age was 58 years (range 13–82), 75.8% were from Europe and 81.8% were male. Nearly 70% of KS patients develop symptoms within 30 min after administration. Chest pain (63.6%) and allergic reaction (75.8%) were the most common clinical manifestations. Diagnostic evaluation revealed elevated troponin (72.7%), ST-segment elevation (81.2%) and coronary artery stenosis with thrombosis (53.6%). Thirty-two (97.0%) patients recovered completely after discontinuation of amoxicillin and treatments such as steroids and antihistamines.Conclusion: KS is a rare adverse reaction of amoxicillin. Amoxicillin-induced KS should be considered when chest pain accompanied by allergic symptoms, electrocardiogram changes and or elevated levels of myocardial injury markers. Therapeutic management of KS requires simultaneous treatment of cardiac and allergic symptoms. Epinephrine should be used with caution in patients with suspected KS.

中文翻译:

阿莫西林诱发的 Kounis 综合征的临床特征、诊断和治疗

背景:现有证据表明,阿莫西林常与Kounis综合征(KS)的发生有关。本研究旨在探讨阿莫西林所致KS的临床特点。方法:通过中英文数据库检索1972年至2022年5月阿莫西林所致KS的病例报告。结果:共33例KS患者被诊断为阿莫西林所致KS。包括 16 名患者 (48.5%) 接受阿莫西林治疗和 17 名患者 (51.5%) 接受阿莫西林-克拉维酸治疗。中位年龄为 58 岁(范围 13-82 岁),75.8% 来自欧洲,81.8% 为男性。近 70% 的 KS 患者在给药后 30 分钟内出现症状。胸痛(63.6%)和过敏反应(75.8%)是最常见的临床表现。诊断评估显示肌钙蛋白升高 (72.7%),ST 段抬高 (81.2%) 和冠状动脉狭窄伴血栓形成 (53.6%)。32例(97.0%)患者在停用阿莫西林及类固醇和抗组胺药等治疗后完全康复。结论:KS是阿莫西林罕见的不良反应。当胸痛伴有过敏症状、心电图改变和/或心肌损伤标志物水平升高时,应考虑阿莫西林诱发的 KS。KS 的治疗管理需要同时治疗心脏和过敏症状。疑似 KS 患者应慎用肾上腺素。KS是阿莫西林罕见的不良反应。当胸痛伴有过敏症状、心电图改变和/或心肌损伤标志物水平升高时,应考虑阿莫西林诱发的 KS。KS 的治疗管理需要同时治疗心脏和过敏症状。疑似 KS 患者应慎用肾上腺素。KS是阿莫西林罕见的不良反应。当胸痛伴有过敏症状、心电图改变和/或心肌损伤标志物水平升高时,应考虑阿莫西林诱发的 KS。KS 的治疗管理需要同时治疗心脏和过敏症状。疑似 KS 患者应慎用肾上腺素。
更新日期:2022-10-31
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