# 情境 35歲單純UTI個案以trimethoprim-sulfamethoxazole(TMP-SMX、Bactrim DS) 1錠 PO BID × 5天出院。最重要的個案衛教為何?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375239&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

情境 35歲單純UTI個案以trimethoprim-sulfamethoxazole(TMP-SMX、Bactrim DS) 1錠 PO BID × 5天出院。最重要的個案衛教為何?

## 選項

1. 泌尿症狀緩解即停藥。
2. 為加強吸收將藥片磨碎並與制酸劑混合。
3. 每日至少喝8~10杯水以避免結晶尿，完成5天療程；因光敏感避免曝曬並使用防曬；若出現皮疹、水泡、黏膜潰瘍、發燒、腫脹或呼吸困難立即回報；若有sulfa過敏未記錄請告知。 **✔ 正確答案**
4. 為濃縮尿液配牛奶並限水。

**正確答案: 3**

## 解析

TMP-SMX為含磺胺(sulfa)的複合抗生素，廣泛用於單純UTI、中耳炎、旅遊者腹瀉、MRSA皮膚軟組織、Pneumocystis jirovecii肺炎(PJP)預防與治療等。教學重點：(1) 多喝水至少每日8~10杯以避免結晶尿；(2) 按時完成療程；(3) 光敏感 — 防曬、防護衣、避免日曬與日曬機；(4) 磺胺過敏 — 已知過敏為禁忌；皮疹(尤其廣泛、疼痛、水泡、口/眼/生殖器黏膜侵犯)需回報，疑似SJS/TEN應立即急診；(5) 血液學影響 — 顆粒球缺乏、血小板低、溶血性貧血(尤其G6PD缺乏)、葉酸拮抗致巨母細胞性貧血；倦怠、發燒、易瘀青、黃疸須回報；(6) 高血鉀 — TMP抑制腎臟上皮Na通道類似amiloride；高齡、腎功能不全、ACEi、ARB、保鉀利尿劑或鉀補充劑時風險增；(7) 因核黃疸與葉酸效應，懷孕後期應避免；(8) 結晶尿、AKI、與warfarin(INR上升)、methotrexate、sulfonylurea等交互作用，需藥師審視。配牛奶限水、提早停藥、磨碎合制酸劑均不安全。

## 深入解析

充水、完成療程、防曬、留意SJS皮疹與骨髓影響。老年加上RAAS阻斷劑時的高鉀為高頻交互作用。

## 重要概念

- **TMP-SMX (Bactrim)** — 含磺胺複合抗生素，UTI/PJP/MRSA，SJS、高鉀、葉酸拮抗、結晶尿
- **crystalluria prevention** — 每日8-10杯水，可考慮尿液鹼化，預防磺胺類AKI
- **sulfa allergy spectrum** — 輕微皮疹至SJS/TEN，確診過敏為禁忌，需評估celecoxib、thiazide、sulfonylurea等交叉

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