OBJECTIVE: To introduce the
pharmaceutical care for refractory
mycoplasma pneumoniae (MP)
pneumonia combined with
cerebral infarction in
child by
clinical pharmacist, and to improve further
understanding of MP-induced
cerebral infarction and the management level of the
clinical pharmacist.
METHODS:
Clinical pharmacist provided whole
course pharmaceutical care for a
child case of refractory PM
pneumonia complicated with
cerebral infarction admitted to the
Children’s
Hospital of Fudan
University in Oct. 2018. The
drug use in anti-
infection, anti-inflammatory,
treatment of
cerebral infarction, possible
drug interactions and suspected ADR were analyzed during
treatment. RESULTS: The
child admitted to the
hospital for
treatment due to MP
pneumonia. During the
treatment, the
child suffered from
cerebral infarction symptoms. The
child was given a series of
treatment programs, such as
Azithromycin for
injection for anti-
infection,
Methylprednisolone sodium succinate for
injection for anti-
inflammation,
Nadroparin calcium injection for anticoagulation,
Mannitol injection for reducing
intracranial pressure,
Dextran 40 glucose injection anti-
thrombosis, Compound
glycyrrhizin injection for protecting
liver function, Hydrotalcite
tablets for protecting
gastric mucosa,
intravenous immunoglobulin symptomatic supportive
treatment. During the
treatment, due to the poor
therapeutic effect of
Azithromycin for
injection, it was considered that the
patient may have
cerebral infarction caused by refractory MP
infection, so the
patient’s
prognosis was good when
Azithromycin injection was replaced with
Levofloxacin hydrochloride
injection for anti-
infection. For the increase of
liver enzyme during the
treatment,
clinical pharmacist suggested that anti-
infection combined with
liver protection was provided for the
child and then the
liver enzyme returned to normal. During the
treatment,
clinical pharmacist mainly monitored the interaction and possible adverse reactions among
anticoagulants,
glucocorticoids,
liver protecting
drugs,
drugs for reducing cranial
pressure,
antipyretic and
analgesic drugs, and at the same
time, made medication publicity and
education for the
family members of the
child, and inform them of the adverse reactions of
drugs to be paid
attention to and the precautions for taking
stomach protecting
drugs,
glucocorticoids and other
drugs. CONCLUSIONS:
Cerebral infarction caused by refractory MP
pneumonia in
children is because of excessive
immune response directly or indirectly mediated by MP. The principle of
treatment is to inhibit the inflammatory response, to solve the primary
disease, and symptomatic supportive
treatment. Multi-
drug combination is needed in the
course of
treatment, so it is more necessary for the
clinical pharmacist to participate in the whole process and to manage the
drug refinement and ensure the
safety of
drug use.