某院呼吸科侵袭性肺部真菌感染患儿抗真菌药物使用现状分析

Application of Antifungal Agents in Children with Invasive Pulmonary Fungal Infection in Respiratory Department of a Hospital

目的:通过对某儿童专科医院呼吸科住院的侵袭性肺部真菌感染(IPFI)患儿抗真菌药物使用情况进行回顾性分析,了解其使用现状,为临床合理应用抗真菌药物提供参考与建议。方法:调查2016-2018年住院IPFI患儿使用抗真菌药物的情况,通过与真菌感染相关指南及药品说明书儿童用药信息(年龄段、给药剂量、给药频次、给药途径、溶媒选择、给药浓度、是否负荷剂量)进行比对,发现存在的差异。结果:本研究共纳入133例患儿。参照指南,用药指征全部符合指南推荐;抗真菌药物的选择有1例不符合指南推荐;抗真菌药物联用有10例尚无指南推荐。参照药品说明书,共存在105处差异,其中给药剂量存在差异例数最多,共62例;有8例与其他药物的相互作用在说明书中属于禁忌。本研究共发现不良反应31例。结论:用药指征和抗真菌药物选择与指南推荐较一致;抗真菌药物联合使用与指南推荐存在一定的差异;年龄段及用法用量与说明书比较存在差异较大;少数病例抗真菌药物与其他药物的联合使用在说明书中属禁忌,临床给药需更加谨慎;肝肾功能受损及低血钾为最常见的不良反应,用药过程中需及时监测相关指标。

Objective: To retrospectively analyze the application of antifungal agents in children with invasive pulmonary fungal infection(IPFI) in respiratory department of a children’s hospital, and to investigate the current status, so as to provide reference and suggestions for rational clinical application of antifungal agents. Methods: The application of antifungal agents in hospitalized children with IPFI from 2016 to 2018 was investigated, and differences were found by comparison of information of pediatric medication(age, dosage, frequency, route of administration, solvent selection, concentration, loading dose) in fungal infection related guidelines and drug instructions. Results: One hundred and thirty-three children were enrolled in this study. According to the guidelines, all indications were in accordance with the guidelines. The selection of antifungal agents did not meet the recommendation of guidelines in one case. There were 10 cases of drug combination of antifungal agents, which were not recommended by guidelines. According to the drug instructions, there were 105 discrepancies, with the largest number of discrepancies in the dosage, totally 62 cases. There were 8 cases of interactions with other drugs that were contraindicated in the instructions. Thirty-one cases of adverse drug reactions were observed in the study. Conclusion: The indication and drug selection are basically in accordance with the guidelines. There are certain differences between the drug combination of antifungal agents and the guidelines. Age, usage and dosage of antifungal agents are different from drug instructions. In a small number of cases, the drug combination of antifungal agents and other drugs is contraindicated in the drug instructions, and clinical administration needs to be more cautious. Impaired liver and renal function and hypokalemia are the most common adverse drug reactions and should be monitored promptly during the drug administration.