临床药师参与1例声门下区马尔尼菲蓝状菌感染患儿的药学监护  

Participation of Clinical Pharmacists in Pharmaceutical Care for a Child with Subglottic Talaromyces marneffei Infection

作　　者：陈银清[1] 吴玮哲 何艳玲 和凡 岑菡婧 CHEN Yinqing;WU Weizhe;HE Yanling;HE Fan;CEN Hanjing(Dept.of Pharmacy,Maoming People’s Hospital,Guangdong Maoming 525000,China;Dept.of Pharmacy,Guangzhou Women and Children’s Medical Center,Guangzhou 510623,China)

机构地区：[1]茂名市人民医院药剂科,广东茂名525000 [2]广州市妇女儿童医疗中心药学部,广州510623

出　　处：《中国药房》2020年第12期1511-1515,共5页China Pharmacy

基　　金：广东省省级科技计划项目(No.2013B021800043);广州市医药卫生科技项目(No.20171A011254)。

摘　　要：目的:探讨临床药师在声门下区马尔尼菲蓝状菌感染患儿个体化治疗中的作用。方法:临床药师参与1例声门下区马尔尼菲蓝状菌感染患儿的治疗过程。根据患儿声门下区感染病原菌种类(马尔尼菲蓝状菌),临床药师建议停用吸入用布地奈德混悬液,改用伊曲康唑口服液2.5 mg/kg,q12 h,口服,并定期监测肝功能、血钾等指标;但因该口服溶液需申请临时采购,故医师暂时予伊曲康唑胶囊2.5 mg/kg,q12 h,口服,临床药师建议伊曲康唑胶囊应餐后服用,故医师将喂奶方式由q4 h更改为持续泵奶;药品采购后,改用伊曲康唑口服液2.5 mg/kg,q12 h,空腹口服,医师根据临床药师建议,将喂奶方式改为q4 h;待药品采购并换用口服液后,临床药师建议空腹口服,并根据伊曲康唑血药浓度监测结果及其目标范围(0.5~1 mg/L),多次建议调整伊曲康唑口服液剂量直至8.3 mg/kg,q12 h;针对治疗期间出现的腹泻,临床药师综合考虑治疗的有效性和重要性后,建议维持原治疗;同时行出院用药教育。结果:医师均采纳临床药师建议。该患儿病情好转,于治疗48 d后带药出院。结论:临床药师参与马尔尼菲蓝状菌感染患儿的治疗过程,及时协助医师调整并完善用药方案,有助于提高患儿用药的有效性和安全性。OBJECTIVE:To investigate the role of clinical pharmacists on the individualized treatment of children with subglottic Talaromyces marneffei infection.METHODS:The clinical pharmacists participated in the medication procedure for a case of subglottic T.marneffei infection child.The clinical pharmacists suggested that Budesonide suspension for inhalation should be stopped,according to the subglottic infection pathogen type(T.marneffei);Itraconazole oral solution should be chosen and taken orally 2.5 mg/kg,q12 h,and indicators as liver function,blood potassium should be monitored regularly.However,as Itraconazole oral solution needed to be applied for temporary purchase,Itraconazole capsules 2.5 mg/kg,q12 h,p.o.,was administrated temporarily;clinical pharmacists suggested that Itraconazole capsules should be taken after meal,and the doctor changed the feeding mode of milk from q4 h to continuous pumping.After purchased,Itraconazole oral solution was used instead 2.5 mg/kg,q12 h in fasting state,and according the clinical pharmacist’s suggestion,the doctor changed the nursing method to q4 h milk pumping.After purchasing and using oral solution instead,clinical pharmacists suggested taking it at fasting state;according to the monitoring results and target range(0.5-1 mg/L),oral dose of Itraconazole oral solution was finally adjusted to 8.3 mg/kg,q12 h.In view of the diarrhea during the treatment,clinical pharmacists suggested to continue the original treatment after considering the effectiveness and importance of the treatment;at the same time,discharge medication education should be carried out.RESULTS:The doctors adopted the suggestions of the clinical pharmacists.The child got a clinical improvement and was discharged after 48 days.CONCLUSIONS:Clinical pharmacists participate in the treatment of children with T.marneffei infection,timely assist physicians to adjust and improve the medication regimen,which improve the efficacy and safety of medication for children.

关 键 词：临床药师 儿童 声门下狭窄 马尔尼菲蓝状菌感染 药学监护 

分 类 号：R969.3[医药卫生—药理学]