# 情境 10歲(35 kg)兒童快速strep陽性咽炎以penicillin VK 250 mg PO QID × 10天出院。對家長最重要的出院衛教為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375220&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 10歲(35 kg)兒童快速strep陽性咽炎以penicillin VK 250 mg PO QID × 10天出院。對家長最重要的出院衛教為何?

## 選項

1. 與牛奶混合以增進吸收。
2. 為補回缺課，週末加倍劑量。
3. 發燒消失後2天即可停藥。
4. 即使症狀改善也要按時服用完整10天療程以預防風濕熱與腎絲球腎炎；可行時於餐前1小時或餐後2小時空腹服用以利吸收；液劑冷藏並於處方期後丟棄；如出現皮疹、蕁麻疹、腫脹、喘鳴、嚴重腹瀉或血便須回報；抗生素使用12~24小時且不發燒後可返校。 **✔ 正確答案**

**正確答案: 4**

## 解析

Penicillin VK為A型β-溶血性鏈球菌(Streptococcus pyogenes)咽炎的第一線口服抗生素。即使症狀消退仍需完成10天療程(或單次IM benzathine，或某些指引建議5天amoxicillin)以預防急性風濕熱與後鏈球菌腎絲球腎炎。教學要點：(1) 完成10天完整療程並按時(通常QID)服用；(2) 飯前1小時或飯後2小時空腹吸收最佳，胃腸不適可配食物；(3) 液劑冷藏並於處方期後丟棄；(4) 認識過敏 — 皮疹、蕁麻疹、血管性水腫、喘鳴、呼吸困難 — 須急診；輕微皮疹可為非過敏但仍需回報；(5) 嚴重或血便提示C. difficile腸炎時回報；(6) 依CDC與AAP指引，抗生素12~24小時且不發燒可返校；(7) 有症狀的家庭成員可能需要檢測治療；(8) 使用複合口服避孕藥的青少年宜評估備援避孕。發燒消失即停藥、漏藥加倍補回、與牛奶混合(部分相關藥物與含鈣液體會降低吸收，penicillin VK受影響較小，仍建議空腹)皆非優先衛教。

## 深入解析

10天完整療程是風濕熱預防的原則。空腹利吸收，液劑冷藏，注意過敏與C. difficile。

## 重要概念

- **penicillin VK** — 口服penicillin、10天完整療程、A型鏈球菌咽炎第一線、空腹、預防風濕熱
- **streptococcal pharyngitis** — GAS、快速strep檢測、完成抗生素療程、12-24小時無發燒可返校
- **rheumatic fever prevention** — 適當治療鏈球菌咽炎以預防心臟炎、關節炎、舞蹈病等二次併發症

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