摘要

Fusidic acid 為臨床上常用於治療具抗藥性之葡萄球菌等革蘭氏陽性菌的口服抗生素。雖然其作用機制鮮少引發橫紋肌溶解，但若與statins 類降血脂藥品併用，可能因抑制肝臟代謝酵素或特定藥品運輸蛋白等交互作用，進而增加肌肉毒性及橫紋肌溶解風險，因此 fusidic acid 藥品仿單已將其與statins 併用列為禁忌。Pitavastatin因其代謝途徑特殊，一般會被視為交互作用較少之statins，過去也未曾有相關案例報告發表。本文敘述一位長期於心臟科就診使用pitavastatin 的68 歲女性，因背痛至骨科就診，醫師診斷疑似骨髓炎故開立fusidic acid。病人在併用兩者約2 週後出現大腿疼痛，併用至第4 週時產生嚴重疼痛至急診就醫，檢查發現肝炎及橫紋肌溶解症狀，隨即住院治療。期間停用 fusidic acid 與 pitavastatin，並予支持性療法及止痛藥物。住院第九天 creatine-phosphokinase (CPK)、myoglobin、glutamic pyruvic transaminase (GPT) 等數值皆已下降，臨床症狀穩定後出院，改為門診追蹤。後續持續使用pitavastatin，未再出現相關不良反應。本文同時彙整臨床上已發表的交互作用文獻，並探討可能誘發此交互作用之機轉。

 

ABSTRACT

Fusidic acid is an oral antibiotic commonly used to treat drug-resistant Grampositive bacteria, particularly staphylococcal infections. While fusidic acid alone is rarely associated with rhabdomyolysis, concomitant use with statins may lead to significant drug interactions by inhibiting hepatic metabolic enzymes or specific drug transport proteins, resulting in an increased risk of muscle toxicities and rhabdomyolysis. Due to this risk, co-administration of fusidic acid and statins is listed as a contraindication in the fusidic acid package insert. Pitavastatin is generally considered to have a lower potential for drug interactions due to its unique metabolic pathway. No case report with pitavastatin has been published. This report describes a case of a 68-year-old female patient who had been undergoing long-term pitavastatin therapy for cardiovascular disease. She was later prescribed fusidic acid by an orthopedist for suspected osteomyelitis due to back pain. After approximately two weeks of concurrent use, the patient developed bilateral thigh pain that progressively worsened, resulting in severe pain and an emergency department visit by the fourth week. She was subsequently diagnosed with hepatitis and rhabdomyolysis and was hospitalized for treatment. Both fusidic acid and pitavastatin were discontinued, and supportive care and analgesics were administered. By hospital day 9, levels of creatine phosphokinase (CPK), myoglobin, and glutamic pyruvic transaminase (GPT) had decreased, and symptoms had stabilized. She was discharged and followed up in the outpatient clinic. Pitavastatin therapy was resumed without recurrence of adverse effects. This report also provides a review of relevant literature on drug interactions between fusidic acid and statins and potential mechanisms involved.

 

 

Submitted for publication: 2025.05.09; Accepted for publication: 2025.08.03