1例先天性心脏病合并感染性心内膜炎患儿的用药分析和药学监护
|
摘要
目的:为感染性心内膜炎患儿的个体化合理治疗提供参考。方法:针对我院2017年4月收治的1例先天性心脏病合并感染性心内膜炎患儿,临床药师全程提供药学监护,依据患儿个体情况,当治疗效果不佳时,及时查阅指南、文献并结合自身工作经验提出用药建议。结果:患儿使用万古霉素常规剂量38 mg/(kg·d)治疗后,万古霉素血药谷浓度低(1.3μg/mL),治疗效果不佳。临床药师两次提出建议调整万古霉素剂量,第一次调整剂量为45 mg/(kg·d),第二次调整剂量为60 mg/(kg·d),医师均采纳。调整治疗后,患儿体温正常,万古霉素血药谷浓度提高到5.8～6.5μg/mL,病情得到控制。结论:在万古霉素治疗的儿童感染性心内膜炎治疗过程中,临床药师应全程提供药学监护,密切关注万古霉素的的血药谷浓度,以保障患儿合理用药。
OBJECTIVE:To provide reference for optimizing the treatment of children with infective endocarditis. METHODS:Clinical pharmacists provide whole process pharmaceutical care for a child with congenital heart disease and infective endocarditis admitted to our hospital in April 2017. According to the individual situation of child,when therapy efficacy was poor,medication suggestions were put forward by timely referring to the guide and literature as well as combined with pharmacists' work experience.RESULTS:After treatment with vancomycin at normal dose of 38 mg/(kg·d),the vancomycin blood concentration(1.3 μg/mL)was low,and the treatment effect was poor. Clinical pharmacist made two suggestions to adjust the dose of vancomycin. The first dose was 45 mg/(kg·d),the second dose was 60 mg/(kg·d);pediatrician adopt clinical pharmacist recommendations completely.After treatment,the child's body temperature was normal;vancomycin blood trough concentration increased to 5.8-6.5 μg/mL,and the disease was controlled. CONCLUSIONS:During vancomycin treatment of infective endocarditis in children,clinical pharmacists should provide pharmaceutical care throughout the course and pay close attention to the blood trough concentration of vancomycin in order to ensure the rational use of drugs in children.
OBJECTIVE:To provide reference for optimizing the treatment of children with infective endocarditis. METHODS:Clinical pharmacists provide whole process pharmaceutical care for a child with congenital heart disease and infective endocarditis admitted to our hospital in April 2017. According to the individual situation of child,when therapy efficacy was poor,medication suggestions were put forward by timely referring to the guide and literature as well as combined with pharmacists' work experience.RESULTS:After treatment with vancomycin at normal dose of 38 mg/(kg·d),the vancomycin blood concentration(1.3 μg/mL)was low,and the treatment effect was poor. Clinical pharmacist made two suggestions to adjust the dose of vancomycin. The first dose was 45 mg/(kg·d),the second dose was 60 mg/(kg·d);pediatrician adopt clinical pharmacist recommendations completely.After treatment,the child's body temperature was normal;vancomycin blood trough concentration increased to 5.8-6.5 μg/mL,and the disease was controlled. CONCLUSIONS:During vancomycin treatment of infective endocarditis in children,clinical pharmacists should provide pharmaceutical care throughout the course and pay close attention to the blood trough concentration of vancomycin in order to ensure the rational use of drugs in children.
引文
[1]HOEN B,ALLA F,SELTON-SUTY C,et al.Changing profile of infectiveendocarditis:results of a 1-year survey in France[J].JAMA,2002,288(1):75-81.
[2]CHU VH,CABELL CH,BENJAMIN DK,et al.Early predictors of in-hospital death in infective endocarditis[J].Circulation,2004,109(14):1745-1749.
[3]中华医学会儿科学分会心血管学组.儿童感染性心内膜炎的诊断标准建议[J].中华儿科杂志,2010,48(12):Δ913-915.
[4]BALTIMORE RS,GEWITZ M,BADDOUR LM,et al.Infective endocarditis in childhood:2015 update:a scientific statement from the American Heart Association[J].Circulation,2015,132(15):1487-1515.
[5]梁峰,胡大一,沈珠军,等.2015年欧洲心脏病学会关于感染性心内膜炎治疗指南解读[J].中国循证心血管医学杂志,2017,15(4):302-309.
[6]LIU C,BAYER A,COSGROVE SE,et al.Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children[J].Clin Infect Dis,2011,52(3):e18-e55.
[7]万古霉素临床应用剂量专家组.万古霉素临床应用剂量中国专家共识[J].中华传染病杂志,2012,30(11):641-646.
[8]FRYMOYER A,HERSH AL,BENET LZ,et al.Current recommended dosing of vancomycin for children with invasive methicillin-resistant Staphylococcus aureus infections is inadequate[J].Pediatr Infect Dis J,2009,28(5):398-402.
[9]MARCOS LA,CAMINS BC.Successful treatment of vancomycin-intermediate Staphylococcus aureus pacemaker lead infective endocarditis with telavancin[J].Antimicrob Agents Chemother,2010,54(12):5376-5378.
[10]MARQUES-MINANA MR,SAADEDDIN A,PERIS JE.Population pharmacokinetic analysis of vancomycin in neonates.A new proposal of initial dosage guideline[J].Br JClin Pharmacol,2010,70(5):713-720.
[11]GOUTELLE S,NEELY M,BLEYZAC N.Comment:assessment of vancomycin dosing and subsequent serum concentrations in pediatric patients[J].Ann Pharmacother,2011,45(9):1171-1172.
[12]GIACHETTO GA,TELECHEA HM,SPERANZA N,et al.Vancomycin pharmacokinetic-pharmacodynamic parameters to optimize dosage administration in critically ill children[J].Pediatr Crit Care Med,2011,12(6):e250-e254.
[13]LE J,BRADLEY JS,MURRAY W,et al.Improved vancomycin dosing in children using area under the curve exposure[J].Pediatr Infect Dis J,2013,32(4):e155-e163.
[14]田超,史强,赵紫楠,等.儿科患者万古霉素应用剂量有效性的Meta分析[J].中国临床药理学杂志,2018,34(16):1997-2000.
[2]CHU VH,CABELL CH,BENJAMIN DK,et al.Early predictors of in-hospital death in infective endocarditis[J].Circulation,2004,109(14):1745-1749.
[3]中华医学会儿科学分会心血管学组.儿童感染性心内膜炎的诊断标准建议[J].中华儿科杂志,2010,48(12):Δ913-915.
[4]BALTIMORE RS,GEWITZ M,BADDOUR LM,et al.Infective endocarditis in childhood:2015 update:a scientific statement from the American Heart Association[J].Circulation,2015,132(15):1487-1515.
[5]梁峰,胡大一,沈珠军,等.2015年欧洲心脏病学会关于感染性心内膜炎治疗指南解读[J].中国循证心血管医学杂志,2017,15(4):302-309.
[6]LIU C,BAYER A,COSGROVE SE,et al.Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children[J].Clin Infect Dis,2011,52(3):e18-e55.
[7]万古霉素临床应用剂量专家组.万古霉素临床应用剂量中国专家共识[J].中华传染病杂志,2012,30(11):641-646.
[8]FRYMOYER A,HERSH AL,BENET LZ,et al.Current recommended dosing of vancomycin for children with invasive methicillin-resistant Staphylococcus aureus infections is inadequate[J].Pediatr Infect Dis J,2009,28(5):398-402.
[9]MARCOS LA,CAMINS BC.Successful treatment of vancomycin-intermediate Staphylococcus aureus pacemaker lead infective endocarditis with telavancin[J].Antimicrob Agents Chemother,2010,54(12):5376-5378.
[10]MARQUES-MINANA MR,SAADEDDIN A,PERIS JE.Population pharmacokinetic analysis of vancomycin in neonates.A new proposal of initial dosage guideline[J].Br JClin Pharmacol,2010,70(5):713-720.
[11]GOUTELLE S,NEELY M,BLEYZAC N.Comment:assessment of vancomycin dosing and subsequent serum concentrations in pediatric patients[J].Ann Pharmacother,2011,45(9):1171-1172.
[12]GIACHETTO GA,TELECHEA HM,SPERANZA N,et al.Vancomycin pharmacokinetic-pharmacodynamic parameters to optimize dosage administration in critically ill children[J].Pediatr Crit Care Med,2011,12(6):e250-e254.
[13]LE J,BRADLEY JS,MURRAY W,et al.Improved vancomycin dosing in children using area under the curve exposure[J].Pediatr Infect Dis J,2013,32(4):e155-e163.
[14]田超,史强,赵紫楠,等.儿科患者万古霉素应用剂量有效性的Meta分析[J].中国临床药理学杂志,2018,34(16):1997-2000.