临床药师参与1例血液透析伴尿路感染患者万古霉素个体化用药方案制定

Participation of Clinical Pharmacists in Making Individualized Vancomycin Medication for Hemodialysis Patients with Urinary Tract Infection

对临床药师参与的1例血液透析患者伴复杂性尿路感染使用万古霉素的病例进行讨论和分析,分享高通量血透伴复杂性尿路感染使用万古霉素进行抗感染治疗的经验。临床药师结合复杂性尿路感染常见致病菌、耐药情况、万古霉素在高通量血液透析中PK/PD参数、血清药物浓度监测、制定个体化的万古霉素给药方案。通过对药物治疗方案的调整,患者万古霉素血清药物浓度达到治疗窗范围,感染得到了控制,治疗过程中未出现万古霉素相关的肾毒性等不良反应。证实了临床药师在肾衰竭血液透析特殊患者的药物治疗中,能协助医生发挥优化治疗方案的作用,可以改善临床药物治疗效果,促进临床合理用药。

Through analyzing and discussing a case of using vancomycin for the hemodialysis patient with complicated urinary tract infection,in which the clinical pharmacist participated,to share the experiences in tanking vancomycin for anti-infective treatment of high-flux hemodialysis with complicated urinary tract infection.The clinical pharmacists made the individualized vancomycin medication based on the common pathogens and drug resistance in complicated urinary tract infections,PK/PD parameters of vancomycin in high-flux hemodialysis,and serum drug concentration monitoring.By adjusting the drug treatment program,the vancomycin-related serum drug concentration of the patient reached the range of therapeutic window,the infection was controlled,and there was no renal toxicity and other adverse reactions related to vancomycin in the treatment process.Therefore,it was proved that,in the drug treatment of special hemodialysis patients with renal failure,the clinical pharmacists can assist doctors in optimizing the treatment program to improve the clinical drug treatment effect and promote the rational clinical medication.