临床药师参与1例反复发作性胆管炎患儿抗感染治疗的药学实践  

Pharmaceutical Practice of Anti-Infective Treatment for a Child with Recurrent Cholangitis by Clinical Pharmacists

作　　者：王东亮 丁李乙 尤一雯 Wang Dongliang;Ding Liyi;You Yiwen(Huai’an Women and Children’s Health Care Hospital,Jiangsu Huai’an 223001,China;China Medical University,Shenyang 110122,China;Third People’s Hospital of Huai’an,Jiangsu Huai’an 223001,China)

机构地区：[1]淮安市妇幼保健院,江苏淮安223001 [2]中国医科大学,沈阳110122 [3]淮安市第三人民医院,江苏淮安223001

出　　处：《儿科药学杂志》2025年第4期25-29,共5页Journal of Pediatric Pharmacy

摘　　要：目的:对临床药师参与1例肝门空肠吻合术(Kasai手术)后反复发作性胆管炎(RC)患儿的治疗过程进行分析,为RC患儿的治疗提供参考。方法:临床药师根据患儿胆道感染的情况、实验室检查并结合文献证据协助医师优化RC的抗感染方案,处理因长期使用抗菌药物导致的二重感染和细菌耐药,同时为患儿提供全面的药学监护。推荐美罗培南联合万古霉素及复方磺胺甲?唑治疗患儿胆管炎合并血流感染,并建议使用环丙沙星联合甲硝唑作为降阶梯治疗方案。结果:医师采纳临床药师建议,使用复方磺胺甲?唑、环丙沙星等药物,患儿胆管炎最终得到有效控制。结论:在RC的长期管理中适时改变治疗策略能够有效控制患儿的感染情况。Objective:To analyze the treatment process of a child with recurrent cholangitis(RC)after laparoscopic portojejunal anastomosis(Kasai portoenterostomy),and to provide reference for the treatment of RC.Methods:According to the biliary tract infection in children,laboratory tests,and literature evidence,clinical pharmacists assisted clinicians to optimize RC anti-infective regimen,and to deal with the secondary infection and bacterial resistance induced by long-term use of antibiotics,and to provide comprehensive pharmaceutical care for children.Meropenem combined with vancomycin and trimethoprim-sulfamethoxazole was recommended for the treatment of cholangitis complicated with bloodstream infection.Moreover,the deescalation therapy involving ciprofloxacin combined with metronidazole was suggested.Results:The clinicians accepted the clinical pharmacists’advice and used drugs such as compound trimethoprim-sulfamethoxazole and ciprofloxacin to control the cholangitis effectively.Conclusion:The longterm management of RC requires timely adjustment of the therapeutic strategy to effectively control the infection.

关 键 词：胆道闭锁 胆管炎 临床药师 抗感染治疗 药学监护 

分 类 号：R969.3[医药卫生—药理学]