临床药师参与1例侵袭性肺曲霉病治疗的药学监护

Clinical pharmacists participate in the pharmaceutical care of a case of patient with invasive pulmonary aspergillus infection

1例侵袭性肺曲霉病患者,伴随肾功能不全,考虑病情危重,初始抗真菌治疗需兼顾安全性和有效性,结合PK/PD参数和临床案例报道,权衡利弊,药师建议初始伏立康唑静脉给药,但需监测肾功能。当感染得到控制,伏立康唑血药浓度检测在有效范围后立即改为序贯口服,后续需行床旁CRRT治疗时,建议选择对伏立康唑体内药代动力学参数影响相对较小的CVVHDF模式。

The pharmacist recommended that initial voriconazole intravenous administration should be given to a case of invasive pulmonary aspergillus patient with renal insufficiency in a critical condition when considering the safety and effectiveness of an initial antifungal therapy,combining PK/PD parameters with the clinical case reports and weighing the pros and cons,but his renal function needed to be monitored.Sequential oral voriconazole should be immediately chosen when the infection was controlled and the blood drug concentration of voriconazole reached to an effective range.Furthermore,a CVVHDF mode that has a relatively small effect on the pharmacokinetic parameters of voriconazole would be chosen if CRRT treatment is needed.