基于循证证据的Prader-Willi综合征合并肺部感染患儿抗感染治疗的药学思考

Pharmacology thoughts on anti-infective therapy in a pediatric patient with Prader-Willi syndrome complicated with pulmonary infection based on evidence

目的通过介绍Prader-Willi综合征患儿抗感染治疗过程、抗感染药物品种及剂量制定等方面内容,为临床医生和临床药师对该病治疗药物的管理提供参考。方法总结1例Prader-Willi综合征合并肺部感染患儿的抗感染治疗过程,分析其抗感染药物选择及肥胖患儿药物个体化剂量考量。结果患儿痰培养及肺泡灌洗液培养均为多重耐药鲍曼不动杆菌,经过美罗培南、多粘菌素B、头孢哌酮舒巴坦、替加环素、利福平等药物抗感染治疗,预后良好;患儿肥胖,治疗团队基于循证证据制定药物个体化剂量方案。最终患儿感染控制,疗效佳,未发生药物相关不良反应。结论Prader-Willi综合征是儿童特有的基因缺陷病,多数合并体重过大,并发反复感染,在治疗过程中更需要多学科参与,从而达到理想的抗感染疗效,改善患儿预后,提高生存质量。

Objective To introduce the anti-infective treatment process,anti-infective drug varieties and dosage formulation for children with Prader-Willi syndrome,so as to provide references for clinicians and clinical pharmacists to manage the treatment drugs for this disease.Methods The anti-infective treatment process of 1 case of Prader-Willi syndrome complicated with pulmonary infection was summarized,and the selection of anti-infective drugs and the consideration in individualized drug dose in obese children were analyzed.Results Sputum culture and bronchoalveolar lavage fluid culture of this pediatric patient were multi-drug resistant Acinetobacter baumanni.After treatment with meropenem,polymyxin B,cefoperazone/sulbactam,tegacycline and rifampicin,the prognosis was good.Treatment team developed the individualized dose regimen based on evidence-based medicine for the obese children,and the infection control was effective without drug-related adverse reactions.Conclusion Prader-Willi syndrome is a genetic defect unique to children,most of which are associated with excessive weight and complicated with repeated infections.Multidisciplinary participation is more necessary in the treatment process,so as to achieve ideal anti-infection efficacy,improve the prognosis of children and the quality of life.