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OBJECTIVE:To explore the role of clinical pharmacists participating in the individualized treatment for purulent meningitis. METHODS:Clinical pharmacists participated in the therapy for a patient with purulent meningitis complicated with Staphylococcus aureus infection. According to patient's condition,clinical pharmacists assisted physicians to formulate preliminary therapeutic plan. Reviewing relevant guidelines,domestic and foreign literatures,clinical pharmacists suggested to combine with dexamethasone so as to relieve inflammatory reaction. According to the results of drug sensitivity test,based on vancomycin plasma concentration monitoring and population pharmacokinetics model fitting,clinical pharmacists suggested to reduce the dose of vanco-mycin to 0.5 g,ivgtt,q12 h. The pharmaceutical care were conducted throughout the therapy,including efficacy evaluation of an-ti-infective therapy,ADR monitoring,renal function monitoring,etc. RESULTS:Physicians adopted some suggestions of clinical pharmacists. The disease condition of the patient was recovred,and no ADR related to vancomycin was found. On the 16th day, the patient was discharged from the hospital. CONCLUSIONS:Clinical pharmacists participate in treatment of purulent meningitis, assist physicians to optimize therapy plan based on relevant guideline,literature,etiological examination,blood concentration moni-toring and pharmacokinetics model fitting results. It not only guarantee therapeutic efficacy of anti-infective therapy,but also pre-vent and reduce the occurrence of ADR.
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OBJECTIVE:To explore the role of clinical pharmacists in the treatment of pan-drug resistant Acinetobacter bau-mannii infection. METHODS:Clinical pharmacists participated in the treatment for a severe pneumonia case of pan-drug resistant A. baumannii infection. Clinical pharmacists supplied overall pharmaceutical care and suggestions with respects to initial medication scheme evaluation,pathogen judgment,therapy drug selection,ADR disposal,etc.,including anti-infective treatment of moxifloxa-cin 0.4 g,ivgtt,qd+meropenem 0.5 g,ivgtt,q8 h+linezolid 0.6 g,ivgtt,q12 h;anti-pan-drug resistant A. baumannii infection of cefoperazone sodium and sulbactam sodium 3.0 g,ivgtt,q8 h+tigecycline 50 mg,ivgtt,q12 h;liver protection of ademetionine 1, 4-Butanedisulfonate 1.0 g,ivgtt,qd+reduced glutathione 1.8 g,ivgtt,qd. RESULTS:After 25 d treatment,the patient hadn’t been fe-vered,and hemogram and hepatic function index decreased to normal value. CONCLUSIONS:Clinical pharmacist should be en-gage in anti-infective treatment and pharmaceutical care,and provide physicians reasonable medication suggestion so as to promote care rate in the clinic.
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La diarrea es una de las principales causas de morbimortalidad a nivel mundial, por lo tanto es prioritario que el médico disponga de los conocimientos necesarios para el diagnóstico y tratamiento adecuado. La terapéutica inicial siempre debe estar basada en la historia clínica, en el conocimiento de los principales gérmenes causales y en la propia fisiopatología de la enfermedad. En la presente revisión se concluye que, el tratamiento inicial debe ser sintomático dado que los estudios epidemiológicos indican que el mayor número de casos es de origen viral, sin embargo, se debe mantener una evaluación continua del paciente, teniendo presente siempre su edad ya que de ella dependerá la etiología de la enfermedad. En caso de que se sospeche actuación de enterobacterias, parásitos o gérmenes específicos se hacen las sugerencias terapéuticas específicas más efectivas y se indican algunas consideraciones importantes en pacientes inmunocomprometidos.
Diarrhea is a major cause of morbidity and mortality worldwide, therefore it is important that the medical staff has the expertise necessary for appropiate diagnosis and therapeutic measuers. Initial treatment should always be based on clinical history, knowledge of the major causative organisms and the pathophysiology of the disease itself. In this review it is concluded that initial treatment should be symptomatic because epidemiological studies indicate that the greatest number of cases have a viral origin. However, a continuous evaluation of the patient is necsesary, always considering the patient's age, because it is important for etiologic diagnosis. Specific therapeutic suggestions are made for the suspicion of enterobacteria, parasites or suspected specific germs. Some considerations are given for immunocompromised patients.
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Objective To explore the clinical effect of intravenous immunoglobulin(IVIG)on chronic obstructive pulmonary disease(COPD)and fungal infection.Methods Seventy-two COPD patients with fungal infection were randomly and equally divided into conventional and intervention group.Patients in conventional group were treated with common schedule for COPD plus antifungal agents;patients in intervention group received 1 0 g/d IVIG besides routine therapy.Length of hospital stay and prognosis were recorded,and therapeutic effectiveness were evaluated. Results The effectiveness rate of intervention group was significantly higher than that of conventional group ([88.89%,32/36]vs [66.67%,24/36]);the average length of hospital stay was significantly shorter than conven-tional group ([12.62±7.51]d vs [20.81±6.92]d),and mortality was lower than conventional group ([5.56%, 2/36]vs [22.22%,8/36]),the differences were statistically significant (P<0.05).Conclusion IVIG for treating COPD with invasive pulmonary fungal infection can improve therapeutic efficacy,shorten length of hospital stay and decrease mortality rate.
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OBJECTIVE To evaluate bacterial drug resistance detection value in lower respiratory tract infection treatment.METHODS The data of distribution and antimicrobial resistance of clinical strains in sputum samples in patients with lower respiratory tract infection within some periods were collected and analyzed by WHONET software.Meanwhile,the delivery rates and detection positive rates of clinical species and antibiotics application status in clinic were retrospectively analyzed.RESULTS The delivery rates and detection positive rates of clinical species in patients with lower respiratory tract infection within some periods were 67.8% and 55.9%,respectively.The proportion of Gram-negative bacilli and Gram-positive cocci was 82.39% and 14.18%,respectively.Different drug resistance was displayed in different pathogenic bacteria.Resistant rate of Enterobacteriaceae bacteria and non-ferment bacteria against ciprofloxacin and piperacillin/tazobactam was 47.8%,34.8%and 31.5%,44.7%,respectively and resistant rate of S.aureus against levofloxacin was 63.9%.CONCLUSIONS Although the pathogenic bacteria in patients with lower respiratory tract infection show higher drug resistance to general antibiotics,most of patients with lower respiratory tract infection are treated according to clinical experience of doctors,not based on the results of bacterial culture and antimicrobial susceptibility test.Therefore,the results of bacterial culture and antimicrobial susceptibility test do not play a proper role to direct anti-infective therapy in clinic.