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HIV阴性播散型马尔尼菲篮状菌骨髓炎合并肺结核患者的药学监护
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| 篇名： | HIV阴性播散型马尔尼菲篮状菌骨髓炎合并肺结核患者的药学监护 |
| TITLE： | Pharmaceutical care for the HIV-negative patient with disseminated Talaromyces marneffei osteomyelitis complicated by pulmonary tuberculosis |
| 摘要： | 目的 为人类免疫缺陷病毒（HIV）阴性患者播散型马尔尼菲篮状菌（TM）骨髓炎合并肺结核抗感染治疗的药学监护提供参考。方法临床药师参与1例HIV阴性播散型TM骨髓炎合并肺结核患者的治疗全过程，系统评估患者临床症状、体征及检验、影像学结果后，协助医师制定治疗方案及完善诊断，建议给予两性霉素B胆固醇硫酸酯复合物抗真菌治疗和完善结核菌素试验及痰涂片抗酸染色，实时监护患者的临床表现及检验结果；及时发现患者血钾降低，分析原因后，先后建议口服和静脉补钾，并调整治疗方案（改用伊曲康唑，联合异烟肼+利福平+吡嗪酰胺+乙胺丁醇四联抗结核），同时建议监测伊曲康唑血药浓度。此外，临床药师还对患者进行了系统的用药和健康教育。结果医师采纳临床药师的建议，患者治疗后好转出院。临床药师随访1年患者病情治愈，无不良反应发生。结论两性霉素B胆固醇硫酸酯复合物是HIV阴性患者播散型TM骨髓炎的有效治疗药物，延长疗程可防止复发；用药期间临床药师需加强药学监护，保障患者用药安全。 |
| ABSTRACT： | OBJECTIVE To provide references for pharmaceutical care in the anti-infective treatment of disseminated Talaromyces marneffei （TM）osteomyelitis complicated with pulmonary tuberculosis in a human immunodeficiency virus （HIV）-negative patient. METHODS Clinical pharmacists participated in the entire treatment process of a HIV-negative patient with disseminated TM osteomyelitis complicated by pulmonary tuberculosis. The pharmacist assisted the clinician in formulating an individualized treatment plan and improving the diagnosis based on the patient’s clinical symptoms， signs， laboratory tests， and imaging findings. Recommendations included the use of amphotericin B cholesteryl sulfate complex for antifungal therapy， the completion of a tuberculin skin test and sputum acid-fast bacilli test. The pharmacist monitored the patient’s clinical manifestations and laboratory results in real time. Upon timely detection of hypokalemia in the patient， after analyzing the causes， oral and then intravenous potassium supplementation was sequentially recommended， along with adjustments to the treatment plan （switching to itraconazole and combining it with a four-drug antituberculosis regimen of isoniazid+rifampicin+pyrazinamide+ethambutol）. Meanwhile， monitoring of itraconazole blood concentration was also advised. Additionally， the clinical pharmacist closely monitored the patient’s medication adherence and provided medication education. RESULTS The clinicians accepted the clinical pharmacist’s recommendations. The patient improved after treatment and was discharged. One-year follow-up showed that the patient was cured without adverse reactions. CONCLUSIONS Amphotericin B cholesteryl sulfate complex is an effective therapeutic agent for disseminated TM osteomyelitis in HIV-negative patients. Prolonging the course of treatment can prevent recurrence. During therapy， clinical pharmacists should strengthen pharmaceutical care as well as provide medication and health education to ensure patient safety. |
| 期刊： | 2025年第36卷第16期 |
| 作者： | 张清华；何丽庭 |
| AUTHORS： | ZHANG Qinghua，HE Liting |
| 关键字： | 马尔尼菲篮状菌；两性霉素B胆固醇硫酸酯复合物；化脓性骨髓炎；肺结核；药学监护 |
| KEYWORDS： | Talaromyces marneffei； amphotericin B cholesteryl sulfate complex； suppurative osteomyelitis； pulmonary |
| 阅读数： | 8 次 |
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