RESUMO
Augmented renal clearance （ARC）refers to the significant enhancement of patients ’renal function ，which is manifested by the significant increase of glomerular filtration rate ，which increases the clearance of drugs ，and the effective blood drug concentration cannot be achieved under the conventional dose. The efficacy of antibiotics is closely related to the concentration. The influence of renal dysfunction on drug metabolism is an important factor that clinicians should consider when determining the dosage. This article reviews the definition ，risk factors ，occurrence mechanism ，evaluation methods of ARC ，as well as its impact on the pharmacokinetics/pharmacodynamics of antibiotics and administration methods. It is found that ARC widely exists in critically ill patients ，and the risk factors include age （≤50 years old ），brain trauma ，sepsis，multiple trauma ， etc. When using antibiotics in ARC patients ，the therapeutic effect of drugs can be improved by increasing the dosage ，prolonging the duration of administration and increasing the frequency of administration. However ，in order to prevent adverse reactions caused by high concentration accumulation of drugs ，it is recommended to try to combine treatment drug monitoring.
RESUMO
OBJECTIVE： To collect and summarize the pharmacoeconomic studies of adalimumab in the treatment of ankylosing spondylitis， and to explore the economics of adamumab in the treatment of ankylosing spondylitis. METHODS：Retrieved from Medline， Embase， Web of Science， VIP， CJFD and Wanfang databases， Chinese search terms included “adalimumab” “humira” “ankylosing spondylitis” “cost effectiveness” “pharmacoeconomic evaluation” “cost utility” “cost efficacy” etc. English search terms included “Adalimumab” “Humira” “Ankylosing spondylitis” “AS” “Cost effectiveness” “Pharmaceutical economic evaluation” “Pharmacoeconomics” “Cost utility” “Cost efficacy”， etc. The language is Chinese or English.The retrieval time was from January 2002 to May 2019. The pharmacoeconomic studies of adalimumab vs. traditional treatment，adalimumab vs. other biological agents in the treatment of ankylosing spondylitis were collected， including cost analysis， cost-effectiveness analysis， cost-effectiveness analysis and cost-benefit analysis.The included studies were summarized in terms of countires， research method and economic evluation results. RESULTS：Six papers were included， involving six studies. The literature was mainly distributed in the UK， Canada and the Netherlands. The Markov model was most commonly used.The incremental cost-effectiveness ratio of adalimumab in the treatment of ankylosing spondylitis was￡19 275-26 556 in UK， and adalimumab had cost-effectiveness advantage. The cost-effectiveness advantage between adalimumab and other biological agents was varied in different studies. CONCLUSIONS： Compared with conventional therapy， adalimumabhas economic advantages in the treatment of ankylosing spondylitis in UK. But there was lack of relevant research in China， which needs to be carried out urgently.
RESUMO
OBJECTIVE:To explore the method of pharmaceutical care for antifungal drug treatment of new type crypto-coccal meningitis by clinical pharmacist. METHODS:Clinical pharmacist participated in the drug treatment process for a pa-tient with new type cryptococcal meningitis. Clinical pharmacist provided pharmaceutical care in following aspects:assisting doctor to optimize antifungal drugs treatment plan,providing patients pharmaceutical monitoring and medication education, etc. During amphotericin B treatment,the patient developed refractory hypokalemia. Clinical pharmacists suggested doctors to reduce the dose of amphotericin B and additionally use voriconazole for antifungal treatment. RESULTS:The patient devel-oped refractory hypokalemia no more after the plan was adjusted. After 11 weeks of systematic antifungal treatment,the pa-tient was on the mend. CONCLUSIONS:The participation of clinical pharmacist in antifungal treatment of new type cryptococ-cal meningitis indicates that following the instructions,but not lost flexible disposal;providing service actively,and details is guarantee of safety.