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临床药师参与1例大疱性类天疱疮、肺曲霉病合并播散性皮疽诺卡菌感染治疗的药学实践
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| 篇名： | 临床药师参与1例大疱性类天疱疮、肺曲霉病合并播散性皮疽诺卡菌感染治疗的药学实践 |
| TITLE： | Pharmacy practice of clinical pharmacists involved in the treatment of a case of bullous pemphigoid and pulmonary aspergillosis combined with disseminated Nocardia farcinica infection |
| 摘要： | 目的 为大疱性类天疱疮、肺曲霉病合并播散性皮疽诺卡菌感染患者的抗菌药物方案调整、不良反应识别和个体化药学监护提供参考。方法临床药师参与1例大疱性类天疱疮、肺曲霉病合并播散性皮疽诺卡菌感染患者的治疗全过程，结合循证证据协助临床遴选初期抗皮疽诺卡菌感染的联合治疗方案，并及时沟通微生物室以提供早期药敏数据；在患者出现癫痫时甄别可疑药物，并提醒临床亚胺培南西司他丁钠会影响丙戊酸钠疗效，建议将丙戊酸钠换为左乙拉西坦抗癫痫治疗，并停用亚胺培南西司他丁钠；治疗期间，建议临床对伏立康唑、利奈唑胺进行血药浓度监测，并根据监测结果协助临床及时调整用药剂量。结果医生采纳临床药师建议。患者病情好转，带药出院。结论临床药师基于循证医学证据、药敏试验结果和血药浓度监测数据，协助临床为患者选择敏感的抗感染方案；及时识别不良反应并调整治疗方案，并为患者提供全程用药监护，保证了临床药物治疗的安全性和有效性。 |
| ABSTRACT： | OBJECTIVE To provide a reference for the adjustment of antibacterial drug regimens， identification of adverse reactions， and personalized pharmaceutical care for patients with bullous pemphigoid and pulmonary aspergillosis combined with disseminated Nocardia farcinica infection. METHODS Clinical pharmacists participated in the entire treatment process of a patient with bullous pemphigoid and pulmonary aspergillosis combined with disseminated N. farcinica infection. Evidence-based medicine was used to assist in the selection of an initial combined drug regimen against nocardiosis， and timely communication with the microbiology laboratory to provide early antimicrobial susceptibility data. When the patient exhibited epilepsy， the suspected drugs were identified， and it was reminded that imipenem-cilastatin sodium could affect the efficacy of valproic acid. It was suggested to replace valproic acid with levetiracetam for anti-epileptic treatment and to discontinue imipenem-cilastatin sodium. During treatment， it was recommended to monitor the blood concentrations of voriconazole and linezolid， and assist in adjusting the dosage promptly based on the monitoring results. RESULTS The physicians accepted the recommendations of the clinical pharmacists. The patient’s condition improved， and they were discharged with medication. CONCLUSIONS Based on evidence-based medical evidence， antimicrobial susceptibility test results， and blood concentration monitoring data， clinical pharmacists assist clinicians in selecting a sensitive anti-infective regimen for the patient， identifying adverse reactions， adjusting the treatment regimen and providing full-course medication monitoring to ensure the safety and efficacy of clinical drug therapy. |
| 期刊： | 2024年第35卷第16期 |
| 作者： | 邓体瑛；林敏；胡志敏；邹亮；吴志红；刘剑敏；黄蕾 |
| AUTHORS： | DENG Tiying，LIN Min，HU Zhimin，ZOU Liang，WU Zhihong，LIU Jianmin，HUANG Lei |
| 关键字： | 皮疽诺卡菌感染；大疱性类天疱疮；肺曲霉病；癫痫；临床药师；药学监护 |
| KEYWORDS： | Nocardia farcinica infection； bullous pemphi- |
| 阅读数： | 19 次 |
| 本月下载数： | 1 次 |
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