肾病综合征合并真菌感染患儿1例治疗策略分析

Therapeutic Strategy Analysis of A Case of Nephrotic Syndrome Complicated with Fungal Infection

目的 分析免疫功能紊乱患儿抗真菌感染治疗策略,探讨临床药师在制定个体化治疗方案及药学监护中发挥的作用。方法 临床药师参与1例肾病综合征合并真菌感染患儿的治疗过程,在病原未明时综合病情、实验室检验结果和药物特性制定抗感染方案,将他克莫司剂量调整为原剂量的三分之一,通过血药浓度监测等药学监护,观察抗感染及原发病治疗效果。结果 伏立康唑和他克莫司联合用药时,他克莫司剂量调整为原剂量三分之一后血药浓度仍能维持在有效浓度范围,经过2周的治疗后,患儿消化道症状消失、尿蛋白转阴,感染和原发病都得到明显控制。结论 临床药师结合循证证据,从治疗方案选择、给药剂量调整及血药浓度监测等方面开展药学服务,保障了肾病综合征患儿用药的有效性和安全性,有效促进临床合理用药。

Objective To analyze the therapeutic strategies of antifungal infection in children with immune dysfunction,and to explore the role of clinical pharmacists in the formulation of individualized treatment plan and pharmaceutical care.Methods Clinical pharmacists participated in the treatment of children with nephrotic syndrome complicated with fungal infection.When the etiology was unknown,anti-infection plan was formulated based on the condition,laboratory test results and drug characteristics.The dose of tacrolimus was adjusted to one-third of the original dose.Results When voriconazole and tacrolimus were combined,the blood concentration of tacrolimus could still be maintained in the effective concentration range after the dose was adjusted to one-third of the original dose.After 2 weeks of treatment,the digestive tract symptoms disappeared,the urinary protein turned negative,and the infection and primary disease were obviously controlled.Conclusion Clinical pharmacists combined with evidence-based evidence to carry out pharmaceutical care from the aspects of treatment plan selection,dose adjustment and blood concentration monitoring,which guaranteed the effectiveness and safety of medication for children with nephrotic syndrome and effectively promoted clinical rational drug use.