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首页> 外文期刊>The Journal of pharmacy technology: jPT : official publication of the Association of Pharmacy Technicians >Implications of Glycopeptide and Lipopeptide Antibiotics on Asthma Exacerbations in a Patient With Hyper-IgE Syndrome and Chronic Severe Asthma: A Case Report
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Implications of Glycopeptide and Lipopeptide Antibiotics on Asthma Exacerbations in a Patient With Hyper-IgE Syndrome and Chronic Severe Asthma: A Case Report

机译：糖肽和脂肽抗生素对高IGE综合征和慢性严重哮喘患者哮喘发作的影响：案例报告

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Objective:To review and consider the immunomodulatory ramifications of glycopeptide and lipopeptide antibiotics in a patient with severe asthma, hyper-immunoglobulin E (IgE) syndrome, and osteonecrosis of the jaw.Case Summary:A 36-year-old male patient with a pertinent past medical history of hyper-IgE syndrome, severe asthma, and osteonecrosis of the jaw attributed to steroid use initially presented to the emergency department, where imaging of the jaw suggested an infectious process. Following months of vancomycin therapy as an outpatient, the patient was switched to daptomycin to facilitate once-daily infusions. Following this change, the patient experienced significantly less asthma exacerbations and fewer admissions to the hospital for asthma-related issues.Discussion:Though daptomycin is associated with eosinophilia, and this patient's eosinophil counts did increase while on the drug, an inverse relationship developed concerning the number of hospital admissions for asthma exacerbations. A review of the literature indicates that select glycopeptides, such as vancomycin, have pro-inflammatory effects, while other related drugs, such as the lipopeptide daptomycin, may not result in clinical manifestations of an inflammatory process. Tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6 have been implicated in this process. This patient may have been particularly susceptible to the effects of the glycopeptides due to his diagnosis of hyper-IgE syndrome, which has been independently associated with reactive airway diseases.Conclusion:Cytokine migration and activation by select glycopeptide and lipopeptide antibiotics warrant consideration from clinicians when determining the most appropriate treatment regimens. Further research is required to elucidate whether the pro-inflammatory properties of vancomycin warrant a change in first-line therapy to daptomycin in select cases.
机译：目的：回顾和考虑糖肽和脂肽抗生素在严重哮喘、高免疫球蛋白E（IgE）综合征和颌骨坏死患者中的免疫调节作用。病例总结：一名36岁男性患者，既往有过高IgE综合征、严重哮喘和颌骨骨坏死的相关病史，这些病史归因于最初向急诊科提交的类固醇使用，在急诊科，颌骨成像提示感染过程。在门诊接受了数月的万古霉素治疗后，患者改用达托霉素，以便于每天输注一次。在这一变化之后，患者的哮喘恶化明显减少，因哮喘相关问题入院的人数也减少。讨论：尽管达托霉素与嗜酸性粒细胞增多有关，且该患者在服用该药物时嗜酸性粒细胞计数确实增加，但与哮喘恶化住院人数成反比关系。文献综述表明，选择性糖肽，如万古霉素，具有促炎症作用，而其他相关药物，如脂肽达托霉素，可能不会导致炎症过程的临床表现。肿瘤坏死因子α、白细胞介素-1β和白细胞介素-6参与了这一过程。由于诊断为高IgE综合征，该患者可能特别容易受到糖肽的影响，该综合征与反应性气道疾病独立相关。结论：在确定最合适的治疗方案时，临床医生应考虑选择糖肽和脂肽抗生素引起的细胞因子迁移和激活。需要进一步研究，以阐明万古霉素的促炎特性是否需要在某些病例中改变一线治疗方案，使其改为达托霉素。

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