口服Moxifloxacin後之休克

Moxifloxacin常用於呼吸道感染，是新的廣效fluroquinolone類抗生素，並有良好的組織穿透力。我們報告一位41歲紅斑性狼瘡（SLE）以及粟粒性肺結核（miliary tuberculosis）的亞洲女性病人，接受levofloxacin治療粟粒性肺結核，後改為每日口服400毫克moxifloxacin治療皮下結核性膿瘍。服藥後出現頭暈及休克症狀後住院治療。病情穩定後，在密切監測下口服200 ㎎ moxifloxacin，4小時後再度出現休克。排除其他可能的原因後，包括心因性休克（cardiogenic shock）、低血容性休克（hypovolemic shock）、敗血性休克（septic shock）、停止類固醇導致休克（steroid withdrawal-induced shock），以Naranjo probability scale評估認為是moxifloxacin導致休克，中止moxifloxacin並給予支持療法後，休克迅速獲得改善。moxifloxacin 是一種fluoroquinolone類藥物，而fluoroquinolone類藥物可造成過敏性休克，大多數醫生認可moxifloxacin 的安全性，但口服moxifloxacin造成這名病人的休克。如果患者服用門診醫囑開立的口服moxifloxacin後感到不適，醫生應警覺並仔細監測病人血壓，更應該事先告知患者，服藥後如果感到不適時，必須記錄血壓並尋求醫療協助。

Moxifloxacin is a new fluoroquinolone antimicrobial agent with a broad spectrum of activity. Moxifloxacin attains good penetration into respiratory tissues and fluids. Therefore, moxifloxacin is commonly used in airway infection. We reported a patient developed unexpected shock after taking moxifloxacin orally. A 41-year-old Asian female patient with systemic lupus erythematosus (SLE) had received levofloxacin for miliary tuberculosis. Later, levofloxacin was replaced by oral moxifloxacin 400mg once daily for subcutaneous tuberculous abscess. Dizziness and hypotension developed later after oral intake of moxifloxacin and the patient was hospitalized. After the condition became stable, re-challenge of 200 mg moxifloxacin was done under close monitoring. Recurrent shock was noted 4 hours later. Possible causes of shock were excluded and moxifloxacin-induced shock was suggested by using the Naranjo Probability Scale. Moxifloxacin was discontinued and the shock was corrected rapidly. Anaphylactic shock has been associated with the use of fluoroquinolones. Moxifloxacin is one of widely used fluoroquinolones. Most clinicians consider moxifloxacin safe, however oral moxifloxacin caused shock in this patient. Oral antibiotic is common in daily outpatient care. Physicians should be aware of this potentially fatal event and monitor patient's blood pressure (BP) carefully if they feel discomfort after taking oral moxifloxacin. Furthermore, clinicians should inform patients in advance to record their BP if discomfort develops after taking moxifloxacin orally.