İlaç Ateşi
Özet
İlaç ateşi dikkatli bir klinik öykü, fizik muayene ve laboratuvar tetkiklerine rağmen sebebin bulunulamadığı; ilacın uygulanması ile çakışan ve kesilmesinden sonraki 48-72 saat içinde düzelen bir advers ilaç reaksiyonudur. İnsidansının %3 ile %5 arasında olduğu tahmin edilmektedir ve hastanede yatan hastaların yaklaşık %10’unda ateşin sebebi olarak düşünülmektedir. İlaç ateşinin nedeni çok çeşitlidir ve patofizyolojik olarak beş temel mekanizma neticesinde ateşe neden olabilir. Bunlar değişen termoregülatör mekanizmalar, hipersensitivite reaksiyonları, idiyosenkratik (ilaca özgü) reaksiyonlar, ilaç uygulamasına bağlı reaksiyonlar ve ilacın doğrudan farmakolojik etkisinin uzantısı olan reaksiyonlar olarak sınıflandırılmıştır. İlaçlara bağlı gelişen ateş tedavi altındaki hastalarda herhangi bir zamanda ortaya çıkabilmekle beraber en sık olarak tedavinin 7-10. günlerinde karşımıza çıkar. İlaç ateşi tanısı sıklıkla zordur ve hastanın klinik tablosu, laboratuvar tetkikleri ve verilen tedaviler dikkatlice incelendikten sonra dışlama tanısı olarak konulur. Hastanın klinik olarak iyi olduğu bir durumda ortaya çıkan ateşte özellikle de ilaç ateşine neden olma ihtimali yüksek bir ajan kullanıyorsa tanı olarak ön planda düşünülmelidir. Tedavi için en mantıklı yaklaşım; uygunsa en çok rahatsız edici ilacın kesilmesidir. İlaç ateşinin prognozu iyidir.
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