1例肾移植术后严重根霉菌感染患者复杂药物治疗的药学服务

发布时间：2018-05-06 10:16

本文选题：临床药师 + 药学服务　；参考：《中国药学杂志》2017年02期

【摘要】：目的介绍临床药师对1例肾移植术后严重根霉菌感染患者开展药学服务,达到较好的效果。方法临床药师参与1例肾移植术后严重根霉菌感染患者的药物治疗工作,从抗微生物治疗的角度和对移植肾的保护角度推荐患者使用泊沙康唑治疗,同时结合该药的药动学特点、药物相互作用和患者的病情等因素,对药物治疗方案进行优化。结果使用泊沙康唑口服混悬液200 mg qid,与肠内营养液混合给药,患者根霉菌感染得到控制;根据泊沙康唑与他克莫司药物相互作用特点和患者CYP3A5基因型检测结果调整他克莫司用量,整个治疗期间,患者他克莫司血药浓度绝大部分时间控制在4.8~6.7μg·L~(-1)之间,保证了移植肾的安全;同时,通过调整泊沙康唑服药方法、减少麦考酚钠的剂量和补充微生态制剂等措施减轻了患者的腹泻。结论肾移植术后发生严重感染的患者,药物治疗一般比较复杂。临床药师可对此类特殊人群开展药学服务,通过治疗药物监测及药动学知识分析,发挥专业特长,促进此类患者获得最佳的药物治疗。
[Abstract]:Objective to introduce a case of severe Rhizopus infection after renal transplantation. Methods one patient with severe Rhizopus infection after renal transplantation was treated by clinical pharmacists. Posaconazole was recommended from the point of view of antimicrobial therapy and renal allograft protection. At the same time, the pharmacokinetic characteristics, drug interaction and the patient's condition were combined to optimize the drug treatment plan. Results the infection of Rhizopus was controlled by oral suspension of posaconazole 200mg Qido and enteral nutrition solution. The dosage of tacrolimus was adjusted according to the interaction characteristics of posaconazole with tacrolimus and the results of CYP3A5 genotypic test. The plasma concentration of tacrolimus was controlled between 4.8 渭 g / L and 6.7 渭 g / L during the whole treatment period. At the same time, by adjusting the dosages of posaconazole, reducing the dose of mycophenolate sodium and supplementing microecological preparations, the diarrhea of the patients was alleviated. Conclusion Drug therapy is more complicated in patients with severe infection after renal transplantation. Clinical pharmacists can provide pharmaceutical care to this kind of special population. Through monitoring of therapeutic drugs and analysis of pharmacokinetic knowledge, the clinical pharmacists can give full play to their specialty and promote the patients to obtain the best drug treatment.
【作者单位】：广州医科大学附属第二医院药学部;益阳市中心医院药剂科;
【分类号】：R699.2;R519

【参考文献】