治疗流程
请注意药品名称和品牌、药品处方或地区之间的配方/用药途径和剂量可能有所不同。治疗建议针对患者特定群体提出: 查看免责声明
疑似或确诊感染:轻度或无并发症的疾病
立即将患者隔离于负压房间(具有独立卫浴设施),并通知地区传染病部门。所有疑似或确诊病例都应由包括公共卫生官员在内的专家进行管理,以防止出现潜在的紧急情况。
遵循当地感染防控常规。建议采取标准预防措施、接触传播预防措施和飞沫传播预防措施。在照护疑似猴痘病例时,如果怀疑水痘,则推荐采取空气传播预防措施,直至排除水痘。当照护猴痘确诊病例时,推荐穿戴呼吸器。如果要实施产生气溶胶的操作,推荐采取空气传播预防措施。将所有污染材料(例如,亚麻织物、病号服)以及患者的体液/固体废物作为具有潜在传染性的物品进行处理。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
理想情况下,所有可能接触患者、体液或污染物的人员均应已接受天花疫苗接种。[134]World Health Organization. Monkeypox: fact sheet. May 2022 [internet publication]. https://www.who.int/en/news-room/fact-sheets/detail/monkeypox 对于未接种疫苗的接触者,可建议进行暴露后疫苗接种。请参阅预防。
如有可能,妊娠或严重的免疫功能低下医务工作者不应评估或护理疑似或确诊感染的患者。[135]UK Health Security Agency; Public Health Wales; Public Health Agency (Northern Ireland). Principles for monkeypox control in the UK: 4 nations consensus statement. November 2022 [internet publication]. https://www.gov.uk/government/publications/principles-for-monkeypox-control-in-the-uk-4-nations-consensus-statement
针对特定患者群中所有患者的治疗建议
对于疑似或确诊感染且疾病轻微或不复杂的患者,如果无重度或有并发症疾病的高风险,并且家庭评估确定在家中能做到感染预防和疾病控制,则可在家隔离,持续整个感染期。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
考虑将重度疾病风险较高的患者(例如儿童、孕妇、免疫功能低下者、有皮肤疾病者)收入医疗机构,以进行更密切的监测。还应考虑将与脆弱人群一起生活的患者收入院,在这种情况下,无法做到充分的感染预防和控制措施。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 少数有疼痛或感染的皮肤或黏膜病变患者可能需要入院治疗,以进行疼痛管理和/或抗生素治疗。[151]Girometti N, Byrne R, Bracchi M, et al. Demographic and clinical characteristics of confirmed human monkeypox virus cases in individuals attending a sexual health centre in London, UK: an observational analysis. Lancet Infect Dis. 2022 Sep;22(9):1321-8. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00411-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35785793?tool=bestpractice.com
作出个体化决策。应基于诸如疾病严重程度、存在的并发症、患者照护需求、营养和脱水情况、重度疾病危险因素以及疾病恶化时的医疗就诊途径等因素,作出决策。患者应能走动、水和食物摄入情况良好,并且能够管理自己的自我照护。应尽可能使用远程医疗或电话进行随访。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 NHS England: virtual management of confirmed monkeypox cases Opens in new window
在英国,英国卫生安全局(UK Health Security Agency, UKHSA)建议,基于临床医生评估并遵循 UKHSA 指导,疑似或拟诊病例可居家自我隔离。具有西非或中非旅行史的可能或疑似病例可能需要按照具有严重后果的传染病(high consequence infectious disease, HCID)进行管理;与输入性发热性疾病管理机构进行讨论。根据临床或自我隔离的要求,评估所有确诊(或高度拟诊)病例是否需要入院治疗,并向当地卫生防护中心进行通报。[136]UK Health Security Agency. Monkeypox: case definitions. August 2022 [internet publication]. https://www.gov.uk/guidance/monkeypox-case-definitions 英格兰 NHS 建议采用风险分层的临床方法来辅助决策制定。[165]NHS England. Monkeypox. September 2022 [internet publication]. https://www.england.nhs.uk/publication/monkeypox 在英国,猴痘病毒分支(分支 Ⅱb 谱系 B.1)所致当前疫情暴发不再被归类为 HCID。然而,由分支 Ⅰ、分支 Ⅱa 和分支 Ⅱb(非谱系 B.1)所致感染仍被作为 HCID。[193]UK Health Security Agency. HCID status of monkeypox. September 2022 [internet publication]. https://www.gov.uk/guidance/hcid-status-of-monkeypox
关于停止隔离预防措施的决定,应与当地公共卫生部门进行协商。一般而言,应继续采取预防措施,直到所有病损消退,并形成新鲜皮层。[205]Centers for Disease Control and Prevention. Infection prevention and control of monkeypox in healthcare settings. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html UKHSA 建议,在以下情况中,患者可终止居家自我隔离:患者已通过电话或视频通话接受评估,且停止发热达 72 小时,被认为全身状况良好;48 小时无新发病损;无黏膜病损;所有病损均已结痂;所有暴露皮肤(包括面部、手臂和手)的病损均已结痂,痂皮脱落,下方形成一层新鲜皮肤;其他部位病损在患者外出或与他人接触时均能保持遮盖。当患者符合上述临床标准和以下病损标准时,可以不受限制恢复彻底正常活动(完全解除隔离):48 小时内无新发病损;无黏膜病损;并且所有病损(暴露和未暴露区域)均结痂,所有脱落的结痂下方具有完整的皮肤。建议患者避免与免疫功能低下者、孕妇和 <12 岁儿童接触,直到其满足完全解除隔离标准(如果患者的工作需要与任何此类群体密切接触,则建议可能包括停止工作)。[207]UK Health Security Agency. De-isolation and discharge of monkeypox-infected patients: interim guidance. September 2022 [internet publication]. https://www.gov.uk/guidance/de-isolation-and-discharge-of-monkeypox-infected-patients-interim-guidance
患者遵循其地区家庭自我隔离指南很重要。参阅患者讨论,获取更多建议。
针对特定患者群中所有患者的治疗建议
推荐采取对症治疗和支持性治疗。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
疼痛:疼痛管理很重要,因为疼痛常见并且可能剧烈(例如直肠疼痛/直肠炎、病变引起的疼痛、体格检查时不明显的黏膜病变引起的疼痛、淋巴结肿大引起的疼痛、头痛、肌肉疼痛)。建议采用包括非药物和药物治疗的多模式方法。可能需要进行局部和/或全身治疗。疼痛管理策略应个体化、以患者为中心,并根据个体患者的需求和背景量身定制。最初评估疼痛,然后定期评估疼痛控制情况,并根据需要调整疼痛管理。对于难治性病例,可能需要咨询疼痛专科医生。建议延长随访以快速诊断长期伤害感受性综合征。[194]Centers for Disease Control and Prevention. Clinical considerations for pain management of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pain-management.html [195]Hans GH, Wildemeersch D, Meeus I. Integrated analgesic care in the current human monkeypox outbreak: perspectives on an integrated and holistic approach combining old allies with innovative technologies. Medicina (Kaunas). 2022 Oct 15;58(10):1454. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612138 http://www.ncbi.nlm.nih.gov/pubmed/36295614?tool=bestpractice.com 对于轻度疼痛,建议使用非处方药,如对乙酰氨基酚或布洛芬。布洛芬只能以最低有效剂量按控制症状所需的最短时间服用。在评估了与阿片类药物使用相关的获益和风险(例如,便秘、长期使用阿片类药物的使用障碍)后,建议将阿片类药物(如曲马多或吗啡)用于重度疼痛的短期管理(例如,由直肠炎引起的重度直肠疼痛)。根据个案报道,神经性止痛药(如加巴喷丁)已用于某些情况下(如重度直肠炎)疼痛的短期管理。对于口腔病变,建议采用盐水漱口、使用抗菌漱口水(例如,氯己定)和给予局部麻醉剂(例如,利多卡因胶浆)。对于生殖器或肛门直肠病损,建议进行温水坐浴和/或局部使用利多卡因。外用皮质类固醇也可用于生殖器病损;但是,必须考虑在活动性病损上使用这些药物的风险和获益。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 [194]Centers for Disease Control and Prevention. Clinical considerations for pain management of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pain-management.html
直肠炎:疼痛可能为重度,需要疼痛管理(见上文)。可使用皮质类固醇/局部麻醉栓剂或局部用利多卡因凝胶以缓解疼痛、痉挛和炎症。可考虑使用粪便软化剂以减轻排便相关疼痛(特别是当患者使用阿片类镇痛剂时)。如果出现可能需要使用抗生素的并发症(如急性前列腺炎、前列腺脓肿),应转诊到专科。[194]Centers for Disease Control and Prevention. Clinical considerations for pain management of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pain-management.html [197]British Association for Sexual Health and HIV. Monkeypox management recommendations (proctitis). June 2022 [internet publication]. https://www.bashh.org/news/monkeypox-resources
发热:建议使用对乙酰氨基酚来处理发热。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
瘙痒:为了治疗皮疹相关瘙痒,建议使用一种抗组胺药(例如,氯雷他定)。也可考虑外用制剂,如炉甘石洗剂、凡士林或胶态燕麦。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 [194]Centers for Disease Control and Prevention. Clinical considerations for pain management of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pain-management.html
恶心/呕吐:可能使用止吐药(例如昂丹司琼、异丙嗪)进行治疗。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
腹泻:保守治疗;一般不建议使用肠蠕动抑制剂。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
消化不良:可能使用质子泵抑制剂(例如奥美拉唑)进行治疗。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
皮肤护理:建议患者勿抓挠皮肤,并保持皮损处清洁(即,使用无菌盐水或抗菌溶液)和干燥。不应覆盖皮疹。避免使用粘性绷带。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
营养:建议患者保持充足水化和营养。如果这不可能实现,应评估具体原因(例如,疼痛、呕吐、无力),并给予恰当处理(例如,镇痛、使用止吐药)。根据标准推荐,提供维生素 A 补剂,因为此药能帮助伤口愈合和促进眼健康。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
心理健康诊疗:及时识别和评估焦虑和抑郁症状,以便启动基本的社会心理支持策略和一线干预措施,来管理新的焦虑和抑郁症状(例如,自我管理策略、心理或药物治疗)。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
建议使用心理社会支持策略管理睡眠问题(例如睡眠卫生建议)。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
第一选择
发热或轻度疼痛
对乙酰氨基酚: 儿童:10-15 mg/kg,口服/静脉使用,根据需要,每 4-6 小时一次,每日最大剂量 60 mg/kg;成人:1000 mg,口服/静脉使用,根据需要,每 6-8 小时一次,每日最大剂量 4000 mg
或
轻度疼痛
布洛芬: ≥6 月龄儿童:5-10 mg/kg,口服,需要时每 6-8 小时一次,每日最大剂量 40 mg/kg;成人:400 mg,口服,需要时每 4-6 小时一次,每日最大剂量 2400 mg
或
严重疼痛
曲马多: 儿童:咨询专科医生,获取剂量指导;成人:50-100 mg,口服/静脉使用,根据需要,每 4-6 小时一次,每日最大剂量 400 mg
或
严重疼痛
硫酸吗啡: 儿童:咨询专科医生,获取剂量指导;成人:10 mg,口服(速释型),根据需要,每 4 小时一次,每日最大剂量 60 mg;成人:1-4 mg,静脉使用/皮下注射,根据需要,每 4 小时一次
或
严重疼痛
加巴喷丁: 成人:咨询专科医生,获得剂量指导
或
瘙痒
氯雷他定: 体重 >30 kg 的儿童和成人:10 mg,口服,每日一次
或
恶心/呕吐
昂丹司琼: 儿童:0.15 mg/kg,口服/静脉使用,根据需要,每 12 小时一次,最大剂量 8 mg/剂;成人:8 mg,口服,根据需要,每 12 小时一次,或者 4 mg,静脉使用,根据需要,每 8 小时一次
或
恶心/呕吐
异丙嗪: 成人:12.5-25mg,口服,根据需要,每 4-6 小时一次
或
消化不良
奥美拉唑: 体重 5-10 kg 儿童:5 mg,口服/静脉使用,每日一次;体重 10-20 kg 儿童:10 mg,口服/静脉使用,每日一次;体重 ≥20 kg 儿童:20 mg,口服/静脉使用,每日一次;成人:40 mg,口服/静脉使用,每日一次
针对特定患者群中所有患者的治疗建议
监测患者的临床状况是否恶化。告知患者应促使紧急就诊的并发症体征和症状(例如,病损恶化或数量增加、疼痛加重、持续发热、经口摄入减少、视觉症状、呼吸困难、头晕、意识模糊)。此外,还要告知患者监测有无任何持续性、新发或出现改变的症状,如果有,应就诊。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
监测皮损是否有继发性细菌感染(如发红、发热、硬结、疼痛加重、脓性或恶臭分泌物、反复发热),如果有,则应使用适当的口服抗生素治疗。开始使用抗生素治疗的决策以及抗生素选择应基于个体临床评估和当地的抗微生物药物耐药模式。如果怀疑有剥落或更深的软组织感染,应考虑转诊至专科。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 遵循当地常规。
疑似或确诊感染:重度或有并发症疾病,或者发生重度疾病或并发症的风险增加
立即将患者隔离于负压房间(具有独立卫浴设施),并通知地区传染病部门。所有疑似病例都应由包括公共卫生官员在内的专家进行管理,以防止出现潜在的紧急情况。
遵循当地感染防控常规。建议采取标准预防措施、接触传播预防措施和飞沫传播预防措施。在照护疑似猴痘病例时,如果怀疑水痘,则推荐采取空气传播预防措施,直至排除水痘。当照护猴痘确诊病例时,推荐穿戴呼吸器。如果要实施产生气溶胶的操作,推荐采取空气传播预防措施。将所有污染材料(例如,亚麻织物、病号服)以及患者的体液/固体废物作为具有潜在传染性的物品进行处理。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
理想情况下,所有可能接触患者、体液或污染物的人员均应已接受天花疫苗接种。[134]World Health Organization. Monkeypox: fact sheet. May 2022 [internet publication]. https://www.who.int/en/news-room/fact-sheets/detail/monkeypox 对于未接种疫苗的接触者,可建议进行暴露后疫苗接种。请参阅预防。
如有可能,妊娠或严重的免疫功能低下医务工作者不应评估或护理疑似或确诊感染的患者。[135]UK Health Security Agency; Public Health Wales; Public Health Agency (Northern Ireland). Principles for monkeypox control in the UK: 4 nations consensus statement. November 2022 [internet publication]. https://www.gov.uk/government/publications/principles-for-monkeypox-control-in-the-uk-4-nations-consensus-statement
针对特定患者群中所有患者的治疗建议
对于重度或有并发症疾病患者,或者有发生重度疾病或并发症高风险的患者,需收住院,以给予更密切监测和临床诊疗。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 参阅 诊断路径章节,获取符合重症或复杂性疾病标准患者,或者重症风险升高患者的更多信息。
患者可能需要入院治疗疼痛、吞咽困难(吞咽痛)或细菌重叠感染。几乎所有肛周或直肠病变患者均报告了疼痛,且重度直肠疼痛和直肠炎患者需要入院治疗。
如果患者需要住院治疗,则将其转诊至专门的中心行进一步治疗。
在英国,英国卫生安全局(UK Health Security Agency, UKHSA)建议根据临床或自我隔离要求评估所有确诊病例是否需要入院治疗,并向当地卫生防护中心进行通报。将患者收入当地医院负压或中性压力单人病房,配备呼吸道防护装备和个人防护装备(进行恰当的感染防控)。[136]UK Health Security Agency. Monkeypox: case definitions. August 2022 [internet publication]. https://www.gov.uk/guidance/monkeypox-case-definitions
针对特定患者群中所有患者的治疗建议
建议采取对症治疗。遵循当地常规。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
疼痛:疼痛管理很重要,因为疼痛常见并且可能剧烈(例如直肠疼痛/直肠炎、病变引起的疼痛、体格检查时不明显的黏膜病变引起的疼痛、淋巴结肿大引起的疼痛、头痛、肌肉疼痛)。建议采用包括非药物和药物治疗的多模式方法。可能需要进行局部和/或全身治疗。疼痛管理策略应个体化、以患者为中心,并根据个体患者的需求和背景量身定制。最初评估疼痛,然后定期评估疼痛控制情况,并根据需要调整疼痛管理。对于难治性病例,可能需要咨询疼痛专科医生。建议延长随访以快速诊断长期伤害感受性综合征。[194]Centers for Disease Control and Prevention. Clinical considerations for pain management of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pain-management.html [195]Hans GH, Wildemeersch D, Meeus I. Integrated analgesic care in the current human monkeypox outbreak: perspectives on an integrated and holistic approach combining old allies with innovative technologies. Medicina (Kaunas). 2022 Oct 15;58(10):1454. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612138 http://www.ncbi.nlm.nih.gov/pubmed/36295614?tool=bestpractice.com 对于轻度疼痛,建议使用非处方药,如对乙酰氨基酚或布洛芬。布洛芬只能以最低有效剂量按控制症状所需的最短时间服用。在评估了与阿片类药物使用相关的获益和风险(例如,便秘、长期使用阿片类药物的使用障碍)后,建议将阿片类药物(如曲马多或吗啡)用于重度疼痛的短期管理(例如,由直肠炎引起的重度直肠疼痛)。根据个案报道,神经性止痛药(如加巴喷丁)已用于某些情况下(如重度直肠炎)疼痛的短期管理。对于口腔病变,建议采用盐水漱口、使用抗菌漱口水(例如,氯己定)和给予局部麻醉剂(例如,利多卡因胶浆)。对于生殖器或肛门直肠病损,建议进行温水坐浴和/或局部使用利多卡因。外用皮质类固醇也可用于生殖器病损;但是,必须考虑在活动性病损上使用这些药物的风险和获益。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 [194]Centers for Disease Control and Prevention. Clinical considerations for pain management of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pain-management.html
直肠炎:疼痛可能为重度,需要疼痛管理(见上文)。可使用皮质类固醇/局部麻醉栓剂或局部用利多卡因凝胶以缓解疼痛、痉挛和炎症。可考虑使用粪便软化剂以减轻排便相关疼痛(特别是当患者使用阿片类镇痛剂时)。如果出现可能需要使用抗生素的并发症(如急性前列腺炎、前列腺脓肿),应转诊到专科。[194]Centers for Disease Control and Prevention. Clinical considerations for pain management of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pain-management.html [197]British Association for Sexual Health and HIV. Monkeypox management recommendations (proctitis). June 2022 [internet publication]. https://www.bashh.org/news/monkeypox-resources
发热:建议使用对乙酰氨基酚来处理发热。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
瘙痒:为了治疗皮疹相关瘙痒,建议使用一种抗组胺药(例如,氯雷他定)。也可考虑外用制剂,如炉甘石洗剂、凡士林或胶态燕麦。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 [194]Centers for Disease Control and Prevention. Clinical considerations for pain management of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pain-management.html
恶心/呕吐:可能使用止吐药(例如昂丹司琼、异丙嗪)进行治疗。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
腹泻:保守治疗;一般不建议使用肠蠕动抑制剂。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
消化不良:可能使用质子泵抑制剂(例如奥美拉唑)进行治疗。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
第一选择
发热或轻度疼痛
对乙酰氨基酚: 儿童:10-15 mg/kg,口服/静脉使用,根据需要,每 4-6 小时一次,每日最大剂量 60 mg/kg;成人:1000 mg,口服/静脉使用,根据需要,每 6-8 小时一次,每日最大剂量 4000 mg
或
轻度疼痛
布洛芬: ≥6 月龄儿童:5-10 mg/kg,口服,需要时每 6-8 小时一次,每日最大剂量 40 mg/kg;成人:400 mg,口服,需要时每 4-6 小时一次,每日最大剂量 2400 mg
或
严重疼痛
曲马多: 儿童:咨询专科医生,获取剂量指导;成人:50-100 mg,口服/静脉使用,根据需要,每 4-6 小时一次,每日最大剂量 400 mg
或
严重疼痛
硫酸吗啡: 儿童:咨询专科医生,获取剂量指导;成人:10 mg,口服(速释型),根据需要,每 4 小时一次,每日最大剂量 60 mg;成人:1-4 mg,静脉使用/皮下注射,根据需要,每 4 小时一次
或
严重疼痛
加巴喷丁: 成人:咨询专科医生,获得剂量指导
或
瘙痒
氯雷他定: 体重 >30 kg 的儿童和成人:10 mg,口服,每日一次
或
恶心/呕吐
昂丹司琼: 儿童:0.15 mg/kg,口服/静脉使用,根据需要,每 12 小时一次,最大剂量 8 mg/剂;成人:8 mg,口服,根据需要,每 12 小时一次,或者 4 mg,静脉使用,根据需要,每 8 小时一次
或
恶心/呕吐
异丙嗪: 成人:12.5-25mg,口服,根据需要,每 4-6 小时一次
或
消化不良
奥美拉唑: 体重 5-10 kg 儿童:5 mg,口服/静脉使用,每日一次;体重 10-20 kg 儿童:10 mg,口服/静脉使用,每日一次;体重 ≥20 kg 儿童:20 mg,口服/静脉使用,每日一次;成人:40 mg,口服/静脉使用,每日一次
针对特定患者群中所有患者的治疗建议
采用最佳化支持性治疗措施管理患者。注意体液平衡、氧合、营养状况,及时治疗其他继发性细菌感染、处理并发症,以及预防长期后遗症。为了处理由血管内容量损失引起的严重脱水,建议在密切监测液体反应性的情况下,以一次或多次大量快速输液的方式进行静脉或骨内补液。如果患者无法耐受口服营养,可能需给予肠内营养。如果病人情绪激动,对自己、其他患者或医护人员构成威胁,可能需要进行药物治疗。遵循当地常规。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
监测皮损是否有继发性细菌感染(如发红、发热、硬结、疼痛加重、脓性或恶臭分泌物、反复发热),如果有,则应使用适当的口服抗生素治疗。开始使用抗生素治疗的决策以及抗生素选择应基于个体临床评估和当地的抗微生物药物耐药模式。如果怀疑有剥落或更深的软组织感染,应考虑转诊至专科。遵循当地常规。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
及时识别和评估焦虑和抑郁症状,以便启动基本的社会心理支持策略和一线干预措施,来管理新的焦虑和抑郁症状(例如,自我管理策略、心理或药物治疗)。建议使用心理社会支持策略管理睡眠问题(例如睡眠卫生建议)。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
根据标准推荐,提供维生素 A 补剂,因为此药能帮助伤口愈合和促进眼健康。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
参阅并发症,获取并发症管理具体信息。
针对特定患者群中所有患者的治疗建议
监测生命体征、神经系统状态、容量状态、呼吸系统和灌注体征。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
监测实验室检测值,包括全血细胞计数、尿素和电解质,以及肝功能。
评估疼痛、一般状况、营养状况和皮疹特征(即阶段、位置、皮损数量、有无剥落或继发性细菌感染)。
遵循当地常规。
针对特定患者群中部分患者治疗的附加建议
对重症患者、重症风险增加的患者、累及可能导致严重后遗症(包括瘢痕形成或狭窄)的解剖区域(例如,咽部、阴茎包皮、外阴、阴道、尿道、直肠、肛门)的患者,或严重感染患者(尤其是需要清创术等手术干预的患者),考虑给予抗病毒治疗。应在病程早期开始治疗。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 [105]Centers for Disease Control and Prevention. Interim clinical guidance for the treatment of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html
tecovirimat 通常推荐作为一线治疗。其他治疗(例如,brincidofovir、cidofovir、牛痘免疫球蛋白)在以下患者中可视为附加或替代疗法:重症患者,或在初次就诊时进展为重症的风险较高的患者;tecovirimat 治疗后出现临床显著疾病进展,或经 tecovirimat 治疗获得初期改善后复发的患者;严重免疫功能低下的患者;存在 tecovirimat 耐药性忧虑的患者;对 tecovirimat 过敏或因其他原因不能接受 tecovirimat 的患者。应按照病例具体情况并根据临床和其他参数作出决定。brincidofovir 和 cidofovir 不应同时使用。[105]Centers for Disease Control and Prevention. Interim clinical guidance for the treatment of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html 对于完成 14 天治疗后出现持续性或新发病变的任何患者,考虑检测病灶拭子样本检查 tecovirimat 耐药性和采集样本行血浆药代动力学分析(观察药物水平是否低于目标浓度)。已报道 2 例实验室证实的 tecovirimat 耐药。2 例患者均有免疫功能低下的情况,并有进行性猴痘严重表现。他们接受了延长疗程(>14 天)的 tecovirimat 治疗。到目前为止,尚无 tecovirimat 耐药性病毒传播的记录。[204]Centers for Disease Control and Prevention. Update on managing monkeypox in patients receiving therapeutics. November 2022 [internet publication]. https://emergency.cdc.gov/han/2022/han00481.asp
tecovirimat:一种正痘病毒 VP37 包膜包裹蛋白的抑制剂。tecovirimat 在英国和欧洲被批准用于治疗猴痘。在英国,可提供给因重度或复杂性感染入院的有症状患者。目前正通过专门的区域成人传染病中心管理该药的供应。[203]Medicines and Healthcare products Regulatory Agency. Tecovirimat as a treatment for patients hospitalised due to monkeypox viral infection. September 2022 [internet publication]. https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103213 它在美国获批用于治疗天花,但在疫情暴发期间可按照试验用新药扩展使用方案用于治疗猴痘。[105]Centers for Disease Control and Prevention. Interim clinical guidance for the treatment of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html 其有效性已在两项使用正痘病毒的动物模型研究中得到证实,而安全性则已在一项 3 期临床试验中得到证实,该试验纳入了 359 名健康人类志愿者。[210]ClinicalTrials.gov. A trial to assess the safety, tolerability, and pharmacokinetics of the anti-orthopoxvirus compound tecovirimat (SIGA246-008). November 2017 [internet publication]. https://clinicaltrials.gov/ct2/show/NCT02474589 [211]Grosenbach DW, Honeychurch K, Rose EA, et al. Oral tecovirimat for the treatment of smallpox. N Engl J Med. 2018 Jul 5;379(1):44-53. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086581 http://www.ncbi.nlm.nih.gov/pubmed/29972742?tool=bestpractice.com 对于人类猴痘的有效性仅限于病例报告和病例研究。[206]Adler H, Gould S, Hine P, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022 Aug;22(8):1153-62. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00228-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35623380?tool=bestpractice.com [212]Matias WR, Koshy JM, Nagami EH, et al. Tecovirimat for the treatment of human monkeypox: an initial series from Massachusetts, United States. Open Forum Infect Dis. 2022 Aug;9(8):ofac377. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356679 http://www.ncbi.nlm.nih.gov/pubmed/35949403?tool=bestpractice.com [213]Desai AN, Thompson GR 3rd, Neumeister SM, et al. Compassionate use of tecovirimat for the treatment of monkeypox infection. JAMA. 2022 Oct 4;328(13):1348-50. https://jamanetwork.com/journals/jama/fullarticle/2795743 http://www.ncbi.nlm.nih.gov/pubmed/35994281?tool=bestpractice.com [214]O'Laughlin K, Tobolowsky FA, Elmor R, et al. Clinical use of tecovirimat (Tpoxx) for treatment of monkeypox under an investigational new drug protocol: United States, May - August 2022. MMWR Morb Mortal Wkly Rep. 2022 Sep 16;71(37):1190-5. https://www.cdc.gov/mmwr/volumes/71/wr/mm7137e1.htm http://www.ncbi.nlm.nih.gov/pubmed/36107794?tool=bestpractice.com [215]Viguier C, de Kermel T, Boumaza X, et al. A severe monkeypox infection in a patient with an advanced HIV infection treated with tecovirimat: clinical and virological outcome. Int J Infect Dis. 2022 Oct 29;125:135-7. https://www.ijidonline.com/article/S1201-9712(22)00568-9/fulltext http://www.ncbi.nlm.nih.gov/pubmed/36397606?tool=bestpractice.com 根据病例报告,早期使用 tecovirimat 进行治疗可有助于重度直肠炎患者的疼痛控制。[196]Lucar J, Roberts A, Saardi KM, et al. Monkeypox virus-associated severe proctitis treated with oral tecovirimat: a report of two cases. Ann Intern Med. 2022 Aug 18 [Epub ahead of print]. https://www.acpjournals.org/doi/10.7326/L22-0300 http://www.ncbi.nlm.nih.gov/pubmed/35981225?tool=bestpractice.com 但是并无证据对此加以支持。随机对照试验正在开发中,当试验可行时,应鼓励患者入组。[216]Rojek A, Dunning J, Olliaro P. Monkeypox: how will we know if the treatments work? Lancet Infect Dis. 2022 Sep;22(9):1269-70. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00514-X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35931096?tool=bestpractice.com [217]National Institute for Health and Care Research. Efficacy of tecovirimat for the treatment of non-hospitalised patients with confirmed monkeypox: research brief. May 2022 [internet publication]. https://www.nihr.ac.uk/documents/efficacy-of-tecovirimat-for-the-treatment-of-non-hospitalised-patients-with-confirmed-monkeypox-research-brief/30705 [218]University of Oxford. PLATINUM: placebo-controlled randomised trial of tecovirimat in non-hospitalised monkeypox patients. 2022 [internet publication]. https://www.platinumtrial.ox.ac.uk [219]National Institutes of Health. STOMP: study of tecovirimat for human monkeypox virus. 2022 [internet publication]. https://www.stomptpoxx.org/main 最常报告的不良反应为头痛和恶心。tecovirimat 可能使痘病毒产生耐药性,需谨慎用于免疫功能低下患者。如果有治疗指征,建议将 tecovirimat 用作妊娠(或近期妊娠)和母乳喂养女性的一线治疗。然而,尚无关于在妊娠或母乳喂养期间的人类使用数据,该建议是基于动物研究(未在动物研究中观察到对胚胎-胎儿发育的毒性)。[93]Centers for Disease Control and Prevention. Clinical considerations for monkeypox in people who are pregnant or breastfeeding. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pregnancy.html 如果有治疗指征,tecovirimat 应建议作为儿童和青少年的一线药物予以使用。然而,儿童的安全性和有效性数据缺乏。[91]Centers for Disease Control and Prevention. Clinical considerations for monkeypox in children and adolescents. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pediatric.html 如果有治疗指征(例如,晚期或控制不佳的 HIV 感染),建议将 tecovirimat 作为合并 HIV 感染的患者的一线治疗。[98]Centers for Disease Control and Prevention. Clinical considerations for treatment and prophylaxis of monkeypox virus infection in people with HIV. November 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/people-with-HIV.html [99]O'Shea J, Filardo TD, Morris SB, et al. Interim guidance for prevention and treatment of monkeypox in persons with HIV infection: United States, August 2022. MMWR Morb Mortal Wkly Rep. 2022 Aug 12;71(32):1023-8. https://www.cdc.gov/mmwr/volumes/71/wr/mm7132e4.htm http://www.ncbi.nlm.nih.gov/pubmed/35951495?tool=bestpractice.com
brincidofovir:一种正痘病毒核苷酸类似物 DNA 聚合酶抑制剂和 cidofovir 前体药物。其在欧洲获得天花治疗孤儿药资格认定。在美国获批用于治疗天花,但根据美国食品药品监督管理局批准的单名患者紧急使用试验用新药扩展供药方案,可用于治疗选定患者的猴痘。[105]Centers for Disease Control and Prevention. Interim clinical guidance for the treatment of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html 目前尚无 brincidofovir 治疗人类猴痘病例的疗效相关数据。在治疗前和治疗期间需进行肝功能检查,因为 brincidofovir 可能引起血清转氨酶和血清胆红素升高。最常报告的不良反应为腹泻、恶心、呕吐和腹痛。在动物研究中发现 cidofovir 和 brincidofovir 具有致畸性的证据,不应将其用于早期妊娠或母乳喂养的女性。[93]Centers for Disease Control and Prevention. Clinical considerations for monkeypox in people who are pregnant or breastfeeding. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pregnancy.html 仅应在不寻常情况下用于儿童和青少年(例如极为严重的感染、尽管给予 tecovirimat 治疗后疾病仍出现进展、tecovirimat 具有用药禁忌或药物无法获取。[91]Centers for Disease Control and Prevention. Clinical considerations for monkeypox in children and adolescents. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pediatric.html
cidofovir:一种具有抗痘病毒活性的核苷酸类似物抗病毒药物。在美国获批用于治疗 AIDS 患者的巨细胞病毒性视网膜炎,但可考虑用于重度猴痘患者。[105]Centers for Disease Control and Prevention. Interim clinical guidance for the treatment of monkeypox. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html 体外和猕猴激发研究表明 cidofovir 可能对猴痘有所获益。[220]Stittelaar KJ, Neyts J, Naesens L, et al. Antiviral treatment is more effective than smallpox vaccination upon lethal monkeypox virus infection. Nature. 2006 Feb 9;439(7077):745-8. https://www.nature.com/articles/nature04295 http://www.ncbi.nlm.nih.gov/pubmed/16341204?tool=bestpractice.com [221]Huggins J, Goff A, Hensley L, et al. Nonhuman primates are protected from smallpox virus or monkeypox virus challenges by the antiviral drug ST-246. Antimicrob Agents Chemother. 2009 Jun;53(6):2620-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687232 http://www.ncbi.nlm.nih.gov/pubmed/19349521?tool=bestpractice.com 然而,关于 cidofovir 治疗人类猴痘病例的有效性数据非常有限。[222]Fabrizio C, Bruno G, Cristiano L, et al. Cidofovir for treating complicated monkeypox in a man with acquired immune deficiency syndrome. Infection. 2022 Nov 10 [Epub ahead of print]. https://link.springer.com/article/10.1007/s15010-022-01949-x http://www.ncbi.nlm.nih.gov/pubmed/36355271?tool=bestpractice.com [223]Raccagni AR, Candela C, Bruzzesi E, et al. Real-life use of cidofovir for the treatment of severe monkeypox cases. J Med Virol. 2022 Oct 13 [Epub ahead of print]. https://onlinelibrary.wiley.com/doi/10.1002/jmv.28218 http://www.ncbi.nlm.nih.gov/pubmed/36229902?tool=bestpractice.com [224]Mondi A, Gagliardini R, Mazzotta V, et al. Clinical experience with use of oral tecovirimat or intravenous cidofovir for the treatment of monkeypox in an Italian reference hospital. J Infect. 2022 Nov 5 [Epub ahead of print]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9637020 http://www.ncbi.nlm.nih.gov/pubmed/36347428?tool=bestpractice.com 肾毒性限制了其作为一线药物的应用。可使用丙磺舒,同时予以补液。在动物研究中发现 cidofovir 和 brincidofovir 具有致畸性的证据,不应将其用于早期妊娠或母乳喂养的女性。[93]Centers for Disease Control and Prevention. Clinical considerations for monkeypox in people who are pregnant or breastfeeding. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pregnancy.html 仅应在不寻常情况下用于儿童和青少年(例如极为严重的感染、尽管给予 tecovirimat 治疗后疾病仍出现进展、tecovirimat 具有用药禁忌或药物无法获取。[91]Centers for Disease Control and Prevention. Clinical considerations for monkeypox in children and adolescents. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/pediatric.html
此类药物在部分国家可能尚有库存,但已无法广泛获取。最好在随机临床试验中使用抗病毒药物,并收集标准化的临床和结局数据。如果不可行,可能根据拓展应用方案使用抗病毒药物。[1]World Health Organization. Clinical management and infection prevention and control for monkeypox: interim rapid response guidance, 10 June 2022. June 2022 [internet publication]. https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1 咨询当地公共卫生部门,获取抗病毒治疗应用指导。
抗病毒治疗可能与 HIV 抗逆转录病毒治疗发生相互作用,建议正在接受抗逆转录病毒治疗的患者保持慎重。然而,截至目前,暂未发现因药物相互作用而排斥在抗逆转录病毒治疗中使用 tecovirimat。咨询当地药师,获取更多信息。[98]Centers for Disease Control and Prevention. Clinical considerations for treatment and prophylaxis of monkeypox virus infection in people with HIV. November 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/people-with-HIV.html [124]British HIV Association. BHIVA rapid guidance on monkeypox virus. October 2022 [internet publication]. https://www.bhiva.org/rapid-guidance-on-monkeypox-virus
University of Liverpool: HIV drug interactions Opens in new window
第一选择
Tecovirimat: 体重 <13 kg 的儿童:请咨询专科医生指导口服剂量;体重 13 kg 至 <25 kg 的儿童:200 mg,口服,每日两次,持续 14 天;体重 25 kg 至 <40 kg 的儿童:400 mg,口服,每日两次,持续 14 天;体重 40 kg 至 <120 kg 的儿童和成人:600 mg,口服,每日两次,持续 14 天;体重 ≥120 kg 的儿童和成人:600 mg,口服,每日 3 次,持续 14 天
更多 Tecovirimat口服 tecovirimat 必须与脂肪餐同服,以确保药物的充分吸收和最大限度地提高血清药物水平。一种 tecovirimat 静脉制剂于 2022 年 5 月 19 日在美国获批用于天花。使用口服或静脉制剂应根据患者的表现严重程度、其他合并症和进食全脂餐的能力(口服制剂所需)进行个体化决策。[98]Centers for Disease Control and Prevention. Clinical considerations for treatment and prophylaxis of monkeypox virus infection in people with HIV. November 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/people-with-HIV.html 静脉制剂是体重 <13 kg 儿童的首选,因为对于这类儿童而言口服制剂难以准确给药。静脉制剂不推荐用于重度肾脏损伤患者,轻至中度肾脏损伤或 <2 岁儿童应谨慎给药。在治疗期间监测肾功能。向专科医生咨询静脉给药剂量。[225]Centers for Disease Control and Prevention. Guidance for tecovirimat use: expanded access investigational new drug protocol during 2022 US monkeypox outbreak. September 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/Tecovirimat.html
已有关于免疫力低下的严重表现者在接受治疗期间出现皮损恶化、不愈合、复发和新发皮损的报道。对于这些患者,可考虑治疗 14 日以上,直至出现临改善(不超过 90 日)。[101]Centers for Disease Control and Prevention. Health alert network (HAN) health advisory: severe manifestations of monkeypox among people who are immunocompromised due to HIV or other conditions. September 2022 [internet publication]. https://emergency.cdc.gov/han/2022/han00475.asp
第二选择
布林西多福韦: 体重 <10 kg 的儿童:6 mg/kg,口服,每周一次,使用 2 剂;体重 10 kg 至 <48 kg 的儿童和成人:4 mg/kg,口服,每周一次,使用 2 剂;体重 ≥48 kg 的儿童和成人:200 mg,口服,每周一次,使用 2 剂
第三选择
西多福韦: 儿童和成人:咨询专科医生,获得剂量指导
针对特定患者群中部分患者治疗的附加建议
关于停止隔离预防措施和出院的决定,应与当地公共卫生部门进行协商。一般而言,应继续采取预防措施,直到所有病损消退,并形成新鲜皮层。[205]Centers for Disease Control and Prevention. Infection prevention and control of monkeypox in healthcare settings. October 2022 [internet publication]. https://www.cdc.gov/poxvirus/monkeypox/clinicians/infection-control-healthcare.html 据报道,少数患者在皮损消退后出现长时间上呼吸道病毒脱落和病毒血症,导致其于院内接受长期隔离。[206]Adler H, Gould S, Hine P, et al. Clinical features and management of human monkeypox: a retrospective observational study in the UK. Lancet Infect Dis. 2022 Aug;22(8):1153-62. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00228-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35623380?tool=bestpractice.com
英国卫生安全局建议,满足以下标准时,可以终止隔离预防措施:根据管理患者的临床团队判断,患者临床状况足以安全解除隔离;患者尿液、咽拭子和加入乙二胺四乙酸(ethylenediamine tetra-acetic acid, EDTA)血样的聚合酶链反应检测结果呈阴性(如果患者入院期间一直状况良好,因此之前未送 EDTA 血样进行检测,则不送血样进行检验亦可接受);48 小时无新发病损,无粘膜病损,且所有病损均已结痂,痂皮脱落,下方皮肤完整。[207]UK Health Security Agency. De-isolation and discharge of monkeypox-infected patients: interim guidance. September 2022 [internet publication]. https://www.gov.uk/guidance/de-isolation-and-discharge-of-monkeypox-infected-patients-interim-guidance
只有满足上述所有临床标准、实验室标准和病损标准时,患者才能从隔离设施/病房出院,至另一医院病房、不同住院设施或居住设施(例如疗养院)。[207]UK Health Security Agency. De-isolation and discharge of monkeypox-infected patients: interim guidance. September 2022 [internet publication]. https://www.gov.uk/guidance/de-isolation-and-discharge-of-monkeypox-infected-patients-interim-guidance
如果以上所有标准均可满足,患者可出院返家,而无需继续隔离。满足临床标准,但不满足实验室标准或病损标准的患者,经治临床医生若评估为安全之举,可予以出院后居家隔离(根据现行公共卫生法规)。[207]UK Health Security Agency. De-isolation and discharge of monkeypox-infected patients: interim guidance. September 2022 [internet publication]. https://www.gov.uk/guidance/de-isolation-and-discharge-of-monkeypox-infected-patients-interim-guidance
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