万古霉素致药物热伴白细胞减少2例的药学监护

Pharmacological monitoring for 2 cases of vancomycin induced fever with leukopenia

为帮助临床医师和药师认识、了解万古霉素致药物热伴白细胞减少的发生机制及处理方法,临床药师通过分析2例使用万古霉素感染控制后出现发热伴白细胞减少病例,结合文献学习、临床特点和诊治过程进行关联性分析,为临床判断万古霉素致药物热伴白细胞减少不良反应提供参考。2例患者分别于使用万古霉素第12、13天出现发热,均在输注万古霉素后1~2 h出现发热,查血常规提示白细胞减少,予以停药2 h后无发热,后白细胞计数恢复正常,根据Naranjo评估量表,对2例患者发生发热伴白细胞减少与怀疑药物万古霉素的关联性进行分析评价,得分为7分,评价关系为很可能有关。临床药师与医师根据药物热发生的时间规律、体温变化特征及伴随的机体反应进行鉴别诊断,证实2例患者发热伴白细胞减少与使用万古霉素有关。临床药师参与临床查房和会诊,可发挥药学专长,优化治疗方案,提高药物治疗的有效性与安全性。

Clinical pharmacists analyzed 2 cases of fever with leukopenia after using vancomycin for infection control,and performed association analysis by combining relevant literature,clinical characteristics,and diagnosis and treatment process,with the aim to help clinicians and pharmacists recognize and understand the mechanism of occurrence and management of vancomycin induced fever with leukopenia,and to provide reference for the clinical judgment of vancomycin-induced adverse reactions such as fever and leukopenia.The 2 patients developed fever at 1-2 hours on the 12th and 13th day after vancomycin infusion,respectively,and routine blood tests indicated leukopenia.The fever resolved on the 2nd day after discontinuation of vancomycin,and the leukocyte count subsequently returned to normal.The association between the occurrence of fever with leukopenia in the 2 patients and the suspected drug,vancomycin,was analyzed and scored according to the Naranjo’s assessment scale,with a score of 7 indicating a probable association.The clinical pharmacists and the physicians confirmed the association of fever with leucopenia with vancomycin use in the 2 patients by a differential diagnosis based on the temporal pattern of the onset of vancomycin induced fever,the characteristics of temperature changes,and the concomitant body reactions.It is concluded that the participation of clinical pharmacists in clinical ward rounds and consultations can bring into play pharmacy expertise,optimize treatment plans and improve the efficacy and safety of drug treatment.