临床药师参与1例成人斯蒂尔病患者抗感染治疗的药学监护实践

Pharmaceutical practice in anti-infective therapy of a patient with adult Still's disease

1例46岁男性患者,主因间断发热、咳嗽1个月余入院。入院诊断为“发热原因待查”,抗感染治疗首次选用注射用头孢西丁钠(2g,q12h,ivgtt)联合盐酸左氧氟沙星注射液(0.5g,qd,ivgtt),用药5d。症状无好转后换用注射用盐酸万古霉素(1g,q12h,ivgtt)联合注射用美罗培南(0.5g,q6h,ivgtt),2d后确诊为“成人斯蒂尔病”合并感染,经与医生协商后换用注射用头孢哌酮钠舒巴坦钠(3g,q12h,ivgtt),同时给予注射用甲泼尼龙琥珀酸钠(40mg,q12h,ivgtt)治疗原发病。症状好转后糖皮质激素逐渐减量并序贯为醋酸泼尼松口服。临床药师在患者的整个治疗过程中结合患者疾病的特殊情况协助医生一起调整治疗方案,并制定药物的监护计划,发现患者凝血指标异常时及时提醒临床医生,保障了患者的用药安全,最终患者病情好转出院。

One 46-year-old male patient was admitted to the hospital mainly due to fever and cough for more than one month.The patient was diagnosed as fever of unknown origin and was treated with cefoxitin sodium for injection(2 g,q 12 h,ivgtt)and levofloxacin hydrochloride injection(0.5 g,qd,ivgtt).5 days later,the symptoms did not improve and antibiotics were changed to vancomycin hydrochloride for injection(1 g,q 12 h,ivgtt)and meropenem for injection(0.5 g,q 6 h,ivgtt).2 days later,he was definitely diagnosed as adult Still's disease.Vancomycin and meropenem were replaced by cefoperazone sodium and sulbactam sodium for injection(3 g,q 12 h,ivgtt)by the advice of clinical pharmacist after communication with physicians.And methylprednisolone sodium succinate for injection(40 mg,q 12 h,ivgtt)with progressive dose reduction followed by oral prednisone acetate were given to him according to the condition of the patient.During the course of the treatment,clinical pharmacists helped physicians to make therapeutic regimen based on the patient's condition,made pharmaceutical plan,timely warned physicians when the coagulation indexes were abnormal,thus to ensure the safety drug use of the patient.And then the patient was discharged with a stable condition.