1例肺土曲霉病患者抗真菌治疗的药学监护

Pharmaceutical care for one case of pulmonary aspergillosis caused by Aspergillus terreus

目的探讨临床药师参与肺土曲霉病患者的药学监护的方法和作用。方法通过分析1例肺土曲霉病患者药物治疗的案例,介绍临床药师在患者发生肝损害时排查可能的药物,向医生先后建议监测伏立康唑血药浓度及其代谢相关基因CYP2C19的基因型,并根据监测结果实施个体化剂量调整的工作。结果医生采纳了临床药师建议,根据CYP2C19基因型结果,调整伏立康唑剂量,患者肺部感染得到控制的同时,肝功能各项生化指标也逐渐恢复正常。结论临床药师参与抗感染治疗及药学监护,协助医生进行个体化给药方案调整,有助于药物治疗的安全性和有效性。

Objective To explore the pattern and effects of clinical pharmacists participating in pharmaceutical care for the patient with pulmonary Aspergillus terreus. Methods By analyzing the drug therapy in one case of pulmonary Aspergillus terreus infection, it was introduced that the clinical pharmacists assisted physicians to analyze the possible reasons of the hepatic damage, and recommended monitoring the plasma concentration and the CYP2C19 genotype of voriconazole, and individualizing the drug dosage based on the monitoring results. Results The doctor adopted the suggestions, after decreasing the dose of voriconazole, the symptoms of the pulmonary infection was improved and the liver functions were back to normal. Conclusion Clinical pharmacists can cooperate with physicians to optimize therapy and to promote rational use of drugs.