Pharmaceutical care of voriconazole combined with micafungin in the treatment of aspergillus endocarditis / 中国药房

ABSTRACT

OBJECTIV E To provide ideas for diagnosis and treatment of fungal endocarditis. METHODS The diagnosis and treatment of 1 case of aspergillus endocarditis participated by clinical pharmacists were analyzed. Clinical pharmacists suggested that blood macrogenomic next-generation sequencing （mNGS）detection and blood microbial culture should be performed to assist in the diagnosis of fungal endocarditis ；considering the mechanism ，target and safety of the drug ，it was suggested to use voriconazole combined with micafungin for antifungal treatment ；through combining with the patient ’s condition and weighing up the pros and cons ，the dose of micafungin was adjusted to 300 mg per day ；clinical pharmacists prevented ，evaluated and dealt with adverse drug reactions during treatment ，and also provided medication guidance and long-term follow-up for the patient after discharge. RESULTS The clinician adopted the advice of the clinical pharmacists. Aspergillus fumigatus was detected in blood mNGS，which bought time for early diagnosis and individualized treatment of the patient. After 1 month treatment of voriconazole combined with micafungin ，the patient ’s condition was well controlled. The alkaline phosphatase and γ-glutamyl transferase of the patient returned to normal after treatment with adenosylmethionine succinate. With the help of medication guidance ，education and discharge follow-up of clinical pharmacists ，the medication compliance of the patient was good and the condition was stable. CONCLUSIONS The clinical pharmacists participate in the diagnosis and treatment process of the patient ，formulate an individualized anti-infective treatment plan for the patient and achieve good results ，which reflect the professional ability and service level of the clinical pharmacist ，and provide ideas for the clinical treatment of fungal endocarditis.