1例头孢他啶阿维巴坦致四肢阵发性痉挛的药学监护

Pharmaceutical care for a patient with paroxysmal spasms of extremities caused by ceftazidime-avibactam

目的探讨临床药师在鉴别药物致阵发性痉挛中的作用,为合理用药提供参考。方法回顾性分析临床药师对1例使用头孢他啶阿维巴坦(CZA-AVI)导致四肢阵发性痉挛患者的药学监护过程。临床药师鉴别、分析并总结了抗菌药物导致神经系统毒性的临床表现、危险因素及处理方法等,结合患者临床症状和检验结果等情况,建议暂先停用多黏菌素B和孟鲁司特钠,并将CZA-AVI剂量减半。医师未采纳CZA-AVI剂量减半的建议,后患者神经系统毒性仍未好转,临床药师再次建议停用CZA-AVI,医师予以采纳。结果临床药师通过分析病情,逐一排查导致四肢阵发性痉挛的相关药物,最终确定CZA-AVI可能是导致该患者发生四肢阵发性痉挛的药物;停用该药后患者症状好转,转入社区医院康复治疗。结论在使用CZA-AVI时,需根据肾功能调整剂量,并警惕其所致的神经系统毒性,尤其是对于高龄、肾功能不全、合并使用多种具有肾毒性及神经系统毒性药物的患者。

OBJECTIVE To explore the role of clinical pharmacists in identifying paroxysmal spasms caused by drugs,and provide reference for rational drug use.METHODS Retrospective analysis was conducted on pharmaceutical care provided by clinical pharmacists for a patient with ceftazidime-avibactam(CZA-AVI)induced paroxysmal spasms.The clinical pharmacists identified,analyzed and summarized the clinical manifestations,risk factors and treatment methods of the nervous system toxicity caused by antibacterial drugs.According to the patient’s clinical symptoms and test results,the clinical pharmacists recommended temporarily discontinuing the use of polymyxin B and montelukast sodium,and halving the dose of CZA-AVI.The physicians did not adopt the recommendation to halve the dose of CZA-AVI,and when the patient’s neurologic toxicity did not improve,the clinical pharmacists again recommended discontinuing CZA-AVI,which was accepted by the physicians.RESULTS Clinical pharmacists analyzed the condition and checked related drugs that caused paroxysmal spasms of extremities one by one,and finally determined that CZA-AVI might be the drug that caused paroxysmal spasms of extremities in the patient.After stopping the drug,the patient’s symptoms improved and was transferred to a community hospital for rehabilitation treatment.CONCLUSIONS The dose of CZA-AVI should be adjusted according to the renal function and the neurotoxicity should be guarded against,especially for patients with advanced age,renal insufficiency,and the combined use of multiple drugs related to nephrotoxicity and neurotoxicity.