1例结核患者并发真菌感染的药学服务实践

Pharmaceutical Care in Tuberculosis Patients with Fungal Infection by Clinical Pharmacists

临床药师参与1例结核患者并发真菌感染治疗的全过程,基于伏立康唑治疗药物监测手段,结合药品说明书、用药指南及文献,为临床医师提供药学服务。治疗过程中,临床药师提出伏立康唑剂量调整建议,与医师共同制定个体化治疗方案并随时调整,提高了治疗效果。结果表明,治疗药物监测是临床药师提供合理用药建议的有效技术手段,有利于提高临床药师干预的可靠性。临床药师通过有效的药学服务,为个体化治疗的逐步完善提供了一定的支持。

Clinical pharmacists participated in the treatment of a case of tuberculosis complicated with fungal infection,provided pharmaceutical services to clinicians based on the therapeutic drug monitoring(TDM)method of voriconazole,combining the drug instructions,guidelines and literature.During the course of treatment,clinical pharmacists put forward suggestions on the dose adjustment of voriconazole,and worked together with clinicians to develop individualized treatment plan,which brought about greater improvements in patient outcome.The results showed that TDM is an effective technical means for clinical pharmacists to provide advice on rational drug use,which greatly enhances the reliability of clinical pharmacists’intervention.Clinical pharmacists provide some support for the gradual improvement of personalized medicine through effective pharmaceutical services.