1例化脓性脑膜炎患者的万古霉素个体化给药实践
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摘要
目的探讨临床药师根据治疗药物监测(TDM)结果进行万古霉素方案调整的药学服务实践模式。方法临床药师跟踪TDM结果,发现1例化脓性脑膜炎患者存在万古霉素TDM结果异常。通过查阅文献,从药物相互作用、PK/PD特点进行分析,逐项排查原因,并结合患者情况向医师提出个体化用药建议。结果医师采纳并更改治疗方案,3 d后复查万古霉素TDM,结果在有效范围,患者病情得到改善。结论临床药师发挥药学优势,将TDM与给药剂量、治疗效果有机结合,参与临床药物治疗,协助医师优化治疗方案,促进临床安全有效用药。
引文
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[2] MATSUMOTO K,TAKESUE Y,OHMAGARI N, et al. Practice guidelines for therapeutic drug monitoring of vancomycin: a consensus review of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring[J]. J Infect Chemother,2013,19(3):365.
[3] RYABK M, LOMAESTRO B, ROTSCHAFER J C, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists[J]. Ame J Health Syst Pharm,2009,66(1):82.
[4] 黄仲义,肖永红,张菁,等.万古霉素临床应用中国专家共识(2011版)[J]. 中国新药与临床杂志,2011,30(8):561.
[5] 曹彬,陈佰义,陈楠,等.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.
[6] 杨立宇,邵传锋.联合使用甘露醇对万古霉素血药浓度的影响[J].黑龙江医学,2015,39(3):312.
[7] PERKINS B A,STRAUSBAUGH L J. Effect of mannitol infusions into the internal carotid artery on entry of two antibiotics into the cerebrospinal fluid and brains of normal rabbits[J]. Antimicrob Agents Chemother,1983,24(3): 339.
[8] 袁波,夏志民,杨明,等.甘露醇渗透性开放血脑屏障的时间窗对脑脊液中药物浓度的影响[J].中国医学创新,2009,6(32):1.
[9] 田叶红,陈佰义.医院获得性细菌性脑膜炎常见病原体及危险因素[J].中国感染与化疗杂志,2012,12(2):158.
[10] 张金萍.脑脊液鼻漏致化脓性脑膜炎的诊治体会[J].中国实用神经疾病杂志,2012,15(1):66.
[11] TUNKEL A R, HARTMAN B J, KAPLAN S L, et al. Practice guidelines for the management of bacterial meningitis[J]. Clin Infect Dis,2004,39(9):1267.
[12] 黄佳,白婕,赵志刚.抗菌药物血脑屏障通透能力概述[J].药品评价,2012,9(35):32.