Phenytoin再次過敏反應之案例

Phenytoin Hypersensitivity after Re-exposure in a Patient with Sensitivity History

在國外已有許多研究結果顯示，因藥品不良反應造成的額外醫療支出可能遠超過疾病本身的治療成本，造成不必要的住院以及延長住院天數，其中又有部分的藥品不良反應是可以預防的。本篇案例報告以一位在醫學中心進行腦部手術後服用phenytoin的病人為例，報告此病人在第一次使用phenytoin時已發生疑似之藥品不良反應，但卻未落實病歷建檔與病患用藥安全教育，導致病人在進行第二次的腦部手術後再度使用相同藥品，發生嚴重的抗癲癇藥品過敏反應(antiepileptic drug hypersensitivity syndrome)而入院治療，造成龐大的醫療花費（台幣116,666元）。因此醫院建立完善的藥品不良反應病例記錄以及病患用藥安全教育是重要保障病人安全之機制，不僅使病人免於因醫療而造成之傷害外，也能免去額外的醫療支出，為健保支出找到節流的方向。

Many studies have shown that the cost of adverse drug events may go beyond the cost of medical treatment itself. Such adverse drug events may cause unnecessary hospitalization and prolong the hospital stay. However, some of them are preventable. In this report, we presented a case who was admitted for hypersensitivity caused by the re-exposure to phenytoin 11 months after the first phenytoin allergy event during her first brain surgery. Because there was no documentation and patient education after the first event, another medical doctor prescribed phenytoin after the second brain surgery. The patient suffered from phenytoin hypersensitivity syndrome and was hospitalized with a considerable medical cost (NT$ 116,666). Establishing a documentation and warning system and to enhance the patient education are important mechanisms to improve drug safety and reduce the expenditure of medical expenses as well.