1例多重耐药非结核分枝杆菌肺病患者抗感染治疗的药学监护

Pharmaceutical Care of Anti-infective Treatment in a Patient with Multidrug-resistant Non-tuberculous Mycobacterium Lung Disease

目的:分析多重耐药非结核分枝杆菌肺病患者抗感染治疗的药学监护过程,为该类患者的救治提供参考。方法:临床药师分析1例多重耐药非结核分枝杆菌肺病患者药敏报告后,建议按照非结核性分枝杆菌(nontuberculous mycobacterium,NTM)药敏试验标准再次行药敏试验,结合药物药代动力学特点,将治疗方案由头孢西丁+亚胺培南/西司他丁钠+乙胺丁醇+克拉霉素调整为头孢西丁+亚胺培南/西司他丁钠+阿米卡星雾化吸入+阿奇霉素+替加环素,治疗20 d后患者病情有所好转;按照NTM药敏试验结果提示,结合患者病情将抗感染治疗方案调整为头孢西丁+阿米卡星+阿奇霉素+替加环素+莫西沙星,治疗20 d后患者病情进一步好转出院,转社区医院继续治疗;临床药师还参与了评估、预防治疗过程中的药物不良反应,并对患者出院后用药进行用药指导。结果:医师采纳了临床药师的建议,经过2次调整治疗方案,患者治疗3个月后,病情得到良好控制,未发生严重不良反应。结论:临床药师参与1例多重耐药非结核分枝杆菌肺病患者的诊疗过程,为其制订了个体化的抗感染治疗方案并取得了良好的效果,体现了临床药师的专业能力和服务水平,为多重耐药非结核分枝杆菌肺病的临床诊疗提供了思路.

Objective:To analyze the pharmaceutical care process of anti-infective treatment in a patient with multidrug-resistant non-tuberculous mycobacterium lung disease,so as to provide reference for the treatment of such patients.Methods:After analyzing the drug susceptibility test report of a patient with multidrug-resistant non-tuberculous mycobacterium lung disease,the clinical pharmacist suggested another drug susceptibility test according to the drug susceptibility test standards of non-tuberculous mycobacterium(NTM).Through a combination with the drug pharmacokinetic characteristics,the treatment regimen was adjusted from cefoxitin+imipenem/cilastatin sodium+ethambutol+clarithromycin to cefoxitin+imipenem/cilastatin sodium+amikacin nebulized inhalation+azithromycin+tigecycline,improving the condition of the patient after 20 days of treatment.According to the drug susceptibility test results of NTM,the anti-infective treatment regimen was adjusted to cefoxitin+amikacin+azithromycin+tigecycline+moxifloxacin based on the patient's condition,after 20 days of treatment,the patient was discharged under further improved condition and was transferred to a community hospital for further treatment.The clinical pharmacist also participated in evaluating and preventing adverse drug reactions in the treatment process,and provided medication guidance for the patient after discharge.Results:The physician followed the advice of the clinical pharmacist and adjusted the treatment regimen twice.After 3 months of treatment,the patient's condition was well controlled and no serious adverse reactions occurred.Conclusion:The clinical pharmacist has participated in the diagnosis and treatment process of a patient with multi‐drug-resistant non-tuberculous mycobacterium lung disease,developed personalized anti-infective treatment regimens for the patient,and achieved good effects,reflecting the professional ability and service level of the clinical pharmacist,and providing ideas for the clinical diagnosis and treatment ofmultidrug-resistant non-tuberculousmycobacteriumlung disease.