Лекарственные лихорадки и гипертермии

Лекарственная лихорадка – это фебрильная реакция, по времени совпадающая и патогенетически связанная с применением лекарственного средства. В обзоре представлены публикации эпидемиологических и клинических исследований, касающихся разнообразных вариантов развития лихорадки вследствие применения фармакологических средств. Рассмотрены лихорадочные реакции, связанные как с иммунной гиперчувствительностью, так и имеющие другие механизмы развития, а также синдромы лекарственной гиперчувствительности, включающие лихорадку как один из синдромов (синдром лекарственно-индуцированной гиперчувствительности, сывороточная болезнь, лекарственная волчанка). Наиболее часто термин «лекарственная лихорадка» используется для определения случаев с изолированным фебрильным повышением температуры тела, не сопровождающихся другими клиническими симптомами, например сыпью или органными поражениями, и имеющих иммунный генез. Установлена связь лекарственной лихорадки с чрезвычайно широким спектром лекарственных средств, но наиболее часто она вызывается бета-лактамными антибиотиками. Высокая вероятность развития лекарственной лихорадки у пациентов отделения реанимации и интенсивной терапии, имеющих высокий риск бактериальной инфекции и получающих длительные курсы антибиотиков. Гиподиагностика лекарственной лихорадки приводит к необоснованному продолжению и усилению антибактериальной терапии, повышению риска ятрогенных осложнений и экономических затрат. Также в обзоре представлены варианты лекарственных гипертермий: злокачественный нейролептический синдром, злокачественная гипертермия, серотониновый синдром, синдром инфузии пропофола и некоторые другие. Несмотря на давнюю историю изучения вопроса, патогенез патологии остается до сих пор непонятным, что не позволяет разработать эффективные методы распознавания, отсутствуют специфические диагностические маркеры и диагноз по-прежнему ставится методом исключения.

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