1例未成年结核性胸膜炎患者使用喹诺酮类药物的药学监护

Pharmaceutical care on one juvenile patient using quinolone drugs for tuberculous pleurisy

1例16岁男性患者,入院诊断为结核性胸膜炎,既往服用异烟肼+利福平+吡嗪酰胺抗结核治疗2个月,疗效欠佳,入院后结核专科医院会诊给予异烟肼+利福喷丁+吡嗪酰胺+莫西沙星+阿米卡星抗结核治疗。该患者未满18岁,考虑到喹诺酮类药物的关节软骨损害,入院第8天,药师建议停用莫西沙星,医生采纳。后患者仍感乏力明显,体温维持在37.2~37.3℃,结核专科医院再次会诊仍建议加用喹诺酮类药物。药师积极查阅相关文献,解析喹诺酮类药物的软骨毒性、在抗结核治疗中的地位及其在青少年患者中的用药安全性。结合该患者个体特点,协同医生分析其应用喹诺酮类药物的获益与风险,并详细告知患者及其家长。入院第14天,患者家长签署知情同意书后给予异烟肼+利福喷丁+吡嗪酰胺+莫西沙星+阿米卡星抗结核治疗方案,入院第17天出院。药师继续随访5个月,患者坚持规律服药,无相关不良反应发生,目前继续随访中。

One16-year-old male patient was diagnosed with tuberculous pleurisy.After using isoniazid+rifampin+pyrazinamidefor antituberculosis treatment about two months,the patient didn't get obvious improvement.After the consultation of tuberculosis hospital,the patient was given moxifloxacin and amikacin combined with isoniazid,rifapentine and pyrazinamide.Due to the patient's age(under18,juvenile),considering the potential damage of joints and cartilages caused by quinolone drugs,the pharmacists suggested stoppingmoxifloxacin on the8th day of hospitalization.This advice was adopted by the physician.However,the situation of this patient did notimprove.The patient still felt fatigue,and the temperature maintained at37.2~37.3℃.The doctors from tuberculosis hospital held anotherconsultation and insisted the former project,suggesting using quinolone drugs continuously.The pharmacists positively searched theliterature,analyzed the cartilage toxicity,the value of quinolones in antituberculosis treatment,and the safety of quinolones among juvenilepatients.Combining with the characteristics of the individual patient,the pharmacists analyzed the benefit and risk of using moxifloxacinin juvenile with doctors,and told the relevant information specifically to the patient and his parents.On the14th day of hospitalization,thepatient's parents signed the informed consent,and the project from tuberculosis hospital was used.The patient was discharged from thehospital on the17th day.The pharmacists continued to follow up the patient for another5months.So far,there's no adverse reaction and thepatient is still adhering to the treatment.In the near future,the follow-up will be continued.