重症肺囊虫性肺炎的药物治疗方案调整

Adjustment of drug treatment regimens for critical patients with pneumocystis carinii pneumonia

目的:探讨重症肺囊虫性肺炎(pneumocystis carinii pneumonia,PCP)的抗感染治疗方案。方法:通过参与免疫功能抑制病人重症PCP的药物治疗全过程,监测疗效及药品不良反应(ADRs),调整治疗方案。结果:免疫功能抑制合并肺部感染病人在初始抗感染治疗时需注意覆盖PCP。当病人无法耐受高剂量复方磺胺甲唑(SMZ-TMP)或SMZ-TMP初始治疗无效时,临床药师建议可联合卡泊芬净治疗重症PCP。结论:SMZ-TMP与卡泊芬净联合治疗重症PCP,起效快,临床疗效更好,且可减少相关ADRs的发生。

Objective：To investigate the drug treatment regimens for critical patients with pneumocytis carinii pneumonia（PCP）.Methods：Through direct involvement of clinical pharmacists in the whole drug treatment of 2 immonosuppressed patients,the drug treatment regimens for critical patients with PCP were adjusted,and therapeutic drug efficacy was evaluated and adverse drug reactions were closely monitored in the process.Results：The initial anti-infection treatment of immonosuppressed patients with pulmonary infection should cover PCP.When patients were unable to tolerate high doses of sulfamethodxazole-trimethoprim（SMZ-TMP）or initial treatment with SMZ-TMP was invalid,the combination of SMZ-TMP with caspofungin could be recommended to treat critical PCP.Conclusion：Combination of SMZ-TMP with caspofungin for the treatment of severe PCP had the advantages of faster response,better clinical efficacy,and more importantly,lower incidence of adverse drug reactions.