播散性组织胞浆菌感染抗真菌治疗的药学监护

Pharmaceutical Care of Antifungal Drug in Treatment of Disseminated Histoplasmosis

目的探讨临床药师在播散性组织胞浆菌感染患者抗真菌治疗中的药学服务方法。方法临床药师参与播散性组织胞浆菌感染患者的药物治疗过程,从协助医师制定与优化抗感染方案、对用药过程监护、发生药物不良反应处理及用药教育等方面提供药学服务。患者病情严重,合并肾功能损伤,初始选择伊曲康唑治疗,用药4 d疗效不佳,临床药师及时建议将抗真菌方案改为两性霉素B脂质体。患者在用药期间先后出现血肌酐值升高、周围神经病和血钾下降,临床药师建议适当水化、补充碱性物质,营养神经和每日口服补钾处理。结果医师采纳临床药师建议,经14 d的系统抗真菌治疗,患者病情得到控制。结论临床药师参与播散性组织胞浆菌感染患者抗真菌治疗的药学实践,方式得当,效果明显,有助于加强特殊患者临床使用抗菌药物的管理。

Objective To investigate pharmaceutical care of clinical pharmacist in antifungal drug treatment of disseminated histoplasmosis.Methods One clinical pharmacist participated in drug therapy process for a patient with disseminated histoplasmosis.The clinical pharmacist provided pharmaceutical care in following aspects:assisting doctor to develop and optimize treatment strategies of antifungal drugs,providing pharmaceutical monitoring,dealing with adverse drug reaction and medication education,etc.Amphotericin B liposome was suggested by the clinical pharmacist instead of itraconzole to the patient,who was seriously ill with kidney injury and had been treated with itraconzole for 4 days without good curative effect.During the treatment of amphotericin B liposome,the adverse effects were noted such as increased serum creatinine levels,peripheral neuropathy and hypokalemia.Proper hydration,Neurotrophic and daily oral potassium supplement were suggested.Results The physicians adopted the suggestions of clinical pharmacists.After 14 days of systematic antifungal treatment,the patient’s condition was controlled.Conclusion The pharmaceutical practice for medication management of antifungal drug treatment of disseminated histoplasmosis by clinical pharmacists is proper and effective,and can help strengthen management of application of antibiotics in the special patients.