临床药师参与1例播散性格特隐球菌感染患者长期治疗的药学监护实践 点击下载
| 论文标题： | 临床药师参与1例播散性格特隐球菌感染患者长期治疗的药学监护实践 |
| 英文标题： | |
| 中文摘要： | 目的 为格特隐球菌重症感染患者的药学监护提供参考。方法临床药师参与1例播散性格特隐球菌感染（累及肺、中枢神经系统）男性患者的诊治过程。针对该患者初始治疗效果不佳，临床药师结合药敏实验结果建议将伏立康唑作为三唑类替代药物；针对两性霉素B脂质体所致顽固性低钾血症，临床药师协助医师制定强化补钾方案；针对伏立康唑与硝苯地平的相互作用，临床药师积极识别并加强患者血压监测；针对治疗过程中出现的丙型病毒性肝炎，临床药师充分权衡感染治疗优先级，建议暂缓抗丙型肝炎病毒感染治疗；针对伏立康唑的个体化使用，临床药师多次开展治疗药物监测（TDM）；针对患者病灶吸收不佳，临床药师参与多学科团队讨论，明确手术指征。结果医生采纳临床药师建议。经药物治疗和手术干预后，患者病情稳定，带药出院。结论对于格特隐球菌重症感染，临床药师应关注病原体特性、强化不良反应管理、重视药物相互作用、开展TDM、积极参与多学科团队协作，以确保患者治疗的安全性与有效性。 |
| 英文摘要： | OBJECTIVE To provide guidance for pharmaceutical care in patients with severe Cryptococcus gattii infections.METHODS Clinical pharmacists participated in the diagnosis and treatment of a male patient with disseminated Cryptococcus gattii infection （involving the lungs and central nervous system）. Given the patient’s poor response to initial therapy， the clinical pharmacists， based on antimicrobial susceptibility test results， recommended voriconazole as an alternative azole. In response to refractory hypokalemia caused by liposomal amphotericin B， the clinical pharmacists assisted the physician in developing an intensive potassium replacement regimen. Regarding the interaction between voriconazole and nifedipine， the clinical pharmacists proactively identified the risk and intensified monitoring of the patient’s blood pressure. In response to the onset of hepatitis C during treatment， the clinical pharmacists thoroughly weighed the priority of infection treatment and recommended temporarily postponing antiviral therapy for hepatitis C. For the individualized use of voriconazole， the clinical pharmacists repeatedly performed therapeutic drug monitoring （TDM）. Regarding the patient’s poor lesion resolution， the clinical pharmacists participated in multidisciplinary team discussions to clarify the indications for surgery.RESULTS The physician adopted the clinical pharmacists’ recommendations. Following pharmacological treatment and surgical intervention， the patient’s condition stabilized， and he was discharged while still on medication.CONCLUSIONS For severe Cryptococcus gattii infections， clinical pharmacists should focus on pathogen characteristics， strengthen adverse reaction management， pay close attention to drug interactions， conduct TDM， and actively participate in multidisciplinary team collaboration to ensure the safety and efficacy of patient treatment. |
| 期刊： | 2026年第37卷第16期 |
| 作者： | 王楚红；赵芳；陈美芳；周越；樊榕榕；刘彦国；刘一；黄琳；张晓红 |
| 英文作者： | WANG Chuhong，ZHAO Fang， CHEN Meifang，ZHOU Yue，FAN Rongrong，LIU Yanguo，LIU Yi，HUANG Lin，ZHANG Xiaohong |
| 关键字： | 格特隐球菌；重症感染；两性霉素B；氟胞嘧啶；伏立康唑；药学监护 |
| KEYWORDS： | Cryptococcus gattii;severe infection;amphotericin B;flucytosine;Voriconazole;Pharmaceutical care |
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| 文件大小： | 619.60Kb |
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