临床药师参与1例EB病毒性脑炎患者的药学实践

Pharmaceutical practice of clinical pharmacist participation in a patient with Epstein-Barr virus encephalitis

目的探讨临床药师在EB(Epstein-Barr)病毒性脑炎患者治疗过程中的作用。方法临床药师参与1例EB病毒性脑炎患者的诊疗过程。临床药师针对患者疾病生理特点及所用抗菌药物的药代动力学特性,建议将头孢曲松的剂量调整为2 g,q12 h,美罗培南调整为2 g,q8 h;针对感染未控制,建议停用头孢曲松,更改为万古霉素100万U,q12 h;根据病原学结果,建议停用阿昔洛韦,更改为更昔洛韦5 mg/kg,q12 h;针对电解质紊乱,考虑可能为甘露醇注射液导致的不良反应,建议停用该药。结果临床医师采纳了临床药师的建议。经治疗,患者好转,准予出院。结论临床药师通过参与EB病毒性脑炎患者的药学监护,协助医师优化了治疗方案,保证了患者用药的有效性和安全性。

OBJECTIVE To investigate the role of clinical pharmacists in the treatment of a patient with Epstein-Barr(EB)virus encephalitis.METHODS Clinical pharmacist participated in drug diagnosis and therapy for a patient with EB virus encephalitis.According to the physiological characteristics of the disease and the pharmacokinetic-pharmacodynamic characteristics of antibiotics,clinical pharmacists suggested that the dose should be adjusted as ceftriaxone 2 g,q12 h+meropenem 2 g,q8 h.Based on the uncontrolled infection of the patient,pharmacists suggested that ceftriaxone should be stopped and vancomycin 1 million U and q12 h should be used as alternative therapy.According to the results of etiology,pharmacists suggested that acyclovir should be discontinued and replaced with ganciclovir 5 mg/kg,q12 h.The electrolyte disturbance of the patient may be adverse drug reactions caused by Mannitol injection,it was recommended to stop the drug.RESULTS The clinician followed the advice of the clinical pharmacists.After treatment,the patient improved and was discharged.CONCLUSIONS Clinical pharmacists can carry out pharmaceutical care for patients with EB virus encephalitis,assist physicians in optimizing the treatment plan of patients,and ensure the effectiveness and safety of drug treatment.