中国药房2024，Vol.35Issue(1)：101-106,6.DOI:10.6039/j.issn.1001-0408.2024.01.18
1例类鼻疽脓毒症患者的全程个体化药学监护
Whole-process individualized pharmaceutical care for a case of melioidosis sepsis
摘要
Abstract
OBJECTIVE To provide reference for the adjustment of antibiotic treatment regimens,identification of adverse reactions,and individualized pharmaceutical care for melioidosis sepsis(MS).METHODS Clinical pharmacists participated in the intensive and eradicating therapeutic processes for an MS patient by using blood concentration and gene detection.Based on the literature,antibiotic treatment regimens of MS were adjusted by determining the blood concentrations of β-lactam and trimethoprim/sulfamethoxazole(TMP/SMZ)and calculating PK/PD parameters.The causes of adverse drug reactions were analyzed and addressed by detecting drug-related gene polymorphisms through high-throughput sequencing.RESULTS Clinical pharmacists used blood concentration and genetic testing methods to propose adjustments to imipenem-cilastatin sodium dosage and analyze the causes of various adverse drug reactions.PK/PD targets were calculated by measuring the blood concentrations of β-lactam and TMP/SMZ.Clinical pharmacists explained to clinical doctors the compliance status of patients with melioidosis in sepsis and non-sepsis stages through reviewing guidelines and literature;the results of blood concentration and genetic test were used to analyze the correlation of neurotoxicity of MS patients with IMP cmin,and it was found that nephrotoxicity was not related to the cmax of TMP/SMZ,but to the patient's water intake.After whole-process antibiotic treatment,the patient's condition improved and was discharged,and the adverse reactions were effectively treated.CONCLUSIONS Clinical pharmacists use blood concentration and genetic tests to assist clinicians in formulating MS treatment regimens,and provide whole-course pharmaceutical care for a MS patient.This method has improved the safety and effectiveness of clinical drug therapy.关键词
类鼻疽脓毒症/β-内酰胺类抗菌药物/复方磺胺甲噁唑/血药浓度/基因检测/药学监护Key words
melioidosis sepsis/β-lactam antibiotic/trimethoprim/sulfamethoxazole/blood concentration/genetic test/pharmaceutical care分类
医药卫生引用本文复制引用
王敏,林叶,赵洁,符香香,吴华,吴琼诗,谢甜..1例类鼻疽脓毒症患者的全程个体化药学监护[J].中国药房,2024,35(1):101-106,6.基金项目
海南省重点研发计划项目(No.ZDYF2022SHFZ050,No.ZDYF2019141) （No.ZDYF2022SHFZ050,No.ZDYF2019141）
海南医学院校级创新科研项目(No.HYYS2022B14) （No.HYYS2022B14）
