临床药师参与1例颈深间隙感染并脓毒性休克抗感染治疗分析

Anti-Infective Treatment for a Case of Deep Neck Space Infection Complicated with Septic Shock by Clinical Pharmacists

目的:探讨临床药师在颈深间隙感染并脓毒性休克患儿治疗中发挥的药学指导作用。方法:临床药师参与1例颈深间隙感染并脓毒性休克患儿的会诊。根据患儿病情特点、病原学及药敏结果,结合抗菌药物的杀菌活性、PK/PD特点以及组织分布等,将用药方案“万古霉素、亚胺培南/西司他丁、甲硝唑氯化钠注射液及注射用头孢曲松钠”调整为“青霉素G每次10万U/kg,q4h静脉滴注,利奈唑胺每次10 mg/kg,q8h静脉滴注,联合哌拉西林钠/他唑巴坦钠每次112.5 mg/kg,q8h静脉滴注”抗感染治疗。结果:医师采纳临床药师会诊建议,连续用药8 d后患儿无明显发热,10 d后患儿无发热,生命体征平稳,转至普儿科继续哌拉西林钠/他唑巴坦钠联合利奈唑胺巩固治疗12 d。整个治疗过程持续32 d,患儿感染症状基本控制,出院继续巩固治疗。结论:临床药师参与优化抗感染治疗方案,可促进抗菌药物的合理使用,提高治疗的有效率和成功率。

Objective:To probe into the pharmaceutical guidance role of clinical pharmacists in the treatment of one child with deep neck space infection complicated with septic shock.Methods:The clinical pharmacists participated into the consultation of a child with deep cervical space infection complicated with septic shock.According to the characteristics of the child’s disease condition,etiology and drug sensitivity results,combined with the bactericidal activity of antibiotics,PK/PD characteristics and tissue distribution,the medication regimen“vancomycin,imipenem/cilastatin,metronidazole sodium chloride injection and ceftriaxone sodium for injection”was adjusted to anti-infective treatment“penicillin G 100,000 U/kg each time,q4h ivgtt,linezolid 10 mg/kg each time,q8h ivgtt,combined with piperacillin sodium/tazobactam sodium 112.5 mg/kg each time,q8h ivgtt”.Results:The clinicians adopted the suggestions of consultation by clinical pharmacists,the child had no significant fever after 8 d of continuous medication,there was no fever after 10 d,and the vital signs were stable.The child was transferred to the department of pediatrics for piperacillin sodium/tazobactam sodium combined with linazolid treatment for 12 d.The entire treatment process lasted for 32 d,the infection symptoms of the child were basically controlled,and the child was discharged with continuous consolidation treatment.Conclusion:The participation of clinical pharmacists in optimizing anti-infective treatment regimens can promote the rational use of antibiotics and increase the effectiveness and success rate of treatment.