# 一位40歲的社區型肺炎個案即將出院，處方為azithromycin Z-Pak（第1天口服500毫克，第2至5天每日250毫克）。哪一項個案衛教最為重要？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375232&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位40歲的社區型肺炎個案即將出院，處方為azithromycin Z-Pak（第1天口服500毫克，第2至5天每日250毫克）。哪一項個案衛教最為重要？

## 選項

1. 症狀改善仍依時服完5劑；可與食物或不與食物併服(腸胃不適時與食物);避免合用QT延長藥；心悸、暈厥、嚴重腹瀉、皮膚或眼睛變黃需回報；制酸劑會降低吸收，相隔2小時。 **✔ 正確答案**
2. azithromycin強效，2日就足夠停藥。
3. 為加強效果配葡萄柚汁服用。
4. 若感覺良好為減少副作用可略過劑量。

**正確答案: 1**

## 解析

阿奇黴素（Zithromax、Z-Pak）是一種巨環類抗生素，半衰期長，可採5天療程（或用於披衣菌感染等之單次1克劑量）。廣泛用於社區型肺炎、非典型肺炎、百日咳、鼻竇炎、青黴素過敏患者的中耳炎，以及性傳染病。重點衛教：(1) 即使症狀改善，仍應按時完成療程，以防止治療失敗和抗藥性；(2) 可隨餐或空腹服用——隨餐服用可減少噁心感，但會略為降低吸收；速釋劑型可彈性調整；(3) 常見腸胃道副作用——噁心、嘔吐、腹痛、腹瀉；若出現嚴重或血性腹瀉（困難梭狀桿菌）應通報；(4) QT間期延長為巨環類藥物之同類警示；出現心悸、暈厥或已知電解質異常應通報；未經處方醫師評估，避免併用其他會延長QT間期之藥物；(5) 肝毒性罕見但可能發生——出現黃疸、深色尿、右上腹痛應通報；(6) 含鋁或鎂之制酸劑會降低吸收——應間隔2小時服用；(7) 長期或高劑量使用曾有聽力喪失之通報；(8) 相較於紅黴素和克拉黴素，阿奇黴素對CYP3A4的抑制作用較弱，但仍具交互作用潛力；應檢視併用藥物。僅服用2天即停藥、飲用葡萄柚汁以及跳過劑量，皆不安全。

## 深入解析

5日Z-Pak完成、制酸劑相隔2小時、留意QT與CDiff。Azithromycin為巨環內酯類中CYP3A4抑制最弱，但仍有交互作用。

## 重要概念

- **azithromycin Z-Pak** — 5日療程、長半衰期、社區肺炎/非典型/STI、QT/GI/CDiff、CYP3A4抑制弱
- **macrolide QT** — 類別警示，心悸與暈厥需回報，避免合用QT延長藥
- **antacid spacing** — Al/Mg制酸劑降低吸收，相隔2小時，確保完整吸收

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