临床药师对抗感染治疗方案评价方法的探讨

Discussion on evaluation method of anti-infective therapy by clinical pharmacist

目的探讨临床药师对抗感染治疗方案的评价方法。方法通过对我院呼吸科1例慢性阻塞性肺疾病急性加重期(AECOPD)患者的抗感染治疗分析,探讨对抗感染治疗方案的评价方法。结果该患者具抗菌药物用药指征,初始经验性治疗覆盖包括耐药铜绿假单胞菌在内的常见呼吸道G-杆菌,选用注射用哌拉西林钠舒巴坦钠联合硫酸阿米卡星注射液的抗感染治疗方案是合理的,但全程使用初始两联抗菌药物至出院则不合理。结论对于抗感染治疗方案的评价,首先需判断是否具有抗菌药物使用指征,然后再综合患者病情的严重程度、既往治疗情况、感染部位的病原学特点、抗菌药物的选择等评价初始经验性治疗方案的合理性。对于有病原学阳性结果者,需结合初始经验性治疗疗效、病原学结果的判读及临床意义、指南推荐、后续药物选择等来综合评价后续治疗方案的合理性。

Objective To discuss the evaluation method of anti-infective therapy by clinical pharmacist. Methods Anti infection therapy for an AECOPD patient in department of respiration in our hospital was analyzed to discuss the evaluation method of anti- infective therapy. Results The patient had indication to use antibacterial, and combination of Amikacin and Piperacillin-sulbactam were selected as initial empirical treatment for common respiratory G--bacilli including drug resistant of Pseudomonas aeruginosa, which was rationality. But the whole process of using the initial combination linked to the hospital was unreasonable. Conclusion To evaluate the rationality of anti-infection treatment, the indication to use antibacterial need to be determined firstly, and combined with the severity of the patient, prior treatment, etiology of the site of infection, and choice of antibiotics to evaluate the rationality of initial empiric regimen secondly. For etiology positive results, the efficacy of initial empiric therapy, interpretation of etiology results and the clinical significance, guidelines recommend should be combined, following-up selection of drug to evaluate the rationality of follow up treatment.