临床药师参与1例妊娠伴高脂血症急性胰腺炎患者治疗的药学实践

目的 探讨临床药师在妊娠伴高脂血症急性胰腺炎患者治疗方案制定及用药监护中的作用。方法 临床药师就宁夏医科大学总医院收治的1例高脂血症急性胰腺炎妊娠病例,结合患者病情变化,从药物选择时机、安全性及有效性方面协助医师制订降脂、抗感染及镇痛治疗方案,并开展药学监护。结果 根据患者血脂水平,先后使用非诺贝特及阿托伐他汀钙降脂治疗以及低分子肝素辅助治疗;评估患者腹痛情况,建议给予盐酸哌替啶镇痛治疗;在患者感染控制不佳的情况下,建议抗菌药物由哌拉西林他唑巴坦升级为美罗培南,感染好转后降阶梯为头孢他啶联合甲硝唑,并于感染控制后及时停药。医师采纳临床药师上述建议。治疗后患者体温、血象正常,腹痛好转,血脂下降明显,行剖宫产术,病情平稳转入专科治疗。结论 妊娠患者在药物治疗前,临床药师应根据疾病严重程度,评估药物使用必要性,协助医师制定治疗方案并进行药学监护,确保用药安全有效。     

临床药师参与1例伊朗分枝杆菌感染患者治疗的药学实践

目的 通过对1例颅内感染伊朗分枝杆菌的ICU患者的药学监护,为临床药师开展药学实践提供借鉴。方法 临床药师通过对1例颅内感染伊朗分枝杆菌的ICU患者的药学监护,针对药物相互作用与不良反应进行合理干预,协助临床医师进行治疗决策。结果 临床医师采纳临床药师的建议,患者后期治疗过程顺利。结论 临床药师应密切关注药物相互作用与不良反应,为临床提供合理的药学建议,保障患者用药安全。     

临床药师参与1例门诊高血压病患者治疗的药学实践

目的:探讨临床药师在门诊高血压病患者合理用药中所发挥的作用。方法:临床药师参与1例门诊高血压病患者治疗的全过程,根据药物的临床疗效和患者的病情变化及时调整用药方案,提供个体化的药学服务。结果:临床药师为患者提供药学服务,提高了患者治疗的依从性和临床治疗效果,减少了药品不良反应的发生。结论:临床药师在为患者提供个体化药学服务方面具有自身的优势,能在合理用药中发挥重要作用。     

临床药师参与1例难治性哮喘患儿治疗的药学实践

探讨临床药师参与难治性哮喘患儿治疗药学监护要点,以指导临床合理用药。临床药师参与难治性哮喘的治疗过程,分析产生难治性哮喘原因,寻找疗效与药物、剂量与疗效的关系,制定合理药物及合适剂量,并根据药物的临床疗效和病情变化及时调整用药方案,提供个体化的药学服务。临床药师通过对难治性哮喘的药学监护,可提高患儿的用药安全性及治疗效果。临床药师参与难治性哮喘的治疗的制定,使治疗更加规范、合理,为难治性哮喘的控制治疗提供参考。     

临床药师参与1例特发性肺纤维化治疗的药学实践

目的：评价药师参与特发性肺纤维化治疗的药学实践及对治疗效果的改善情况。方法：药师与医师密切配合,参考《热病》和相关文献及指南,根据患者病情变化和治疗效果及时调整药物治疗方案,密切观察疗效。结果：患者病情较前好转。结论：临床药师参与药物治疗全过程,将药学理论与临床实践有机结合,减少不良反应,促进合理用药。     

临床药师参与1例妊娠合并重症急性胰腺炎治疗的药学实践

目的 探讨临床药师在妊娠合并重症急性胰腺炎患者药物治疗中的作用。方法 临床药师参与1例妊娠合并重症急性胰腺炎患者的药物治疗,建议医师根据临床疗效和病情变化及时调整用药方案,并关注药物对妊娠患者的影响,提供更为全面的药学服务。结果 临床药师为患者提供个体化药学服务,提高了临床治疗效果,减少了药品不良反应。结论 临床药师参与药物治疗实践,有利于提高药物治疗水平。     

临床药师参与妊娠合并哮喘患者的药物治疗实践

目的:探讨临床药师对妊娠合并哮喘患者实施药学监护的作用和意义。方法:临床药师通过参与2例妊娠合并哮喘的案例分析,给予药学建议:换用青霉素类抗感染治疗和硫酸镁联合多索茶碱静脉滴注、沙丁胺醇雾化治疗方案。结果:采纳临床药师建议并予适当处理后患者哮喘症状得到明显缓解出院。结论:临床药师参与妊娠合并哮喘患者的药学监护,能有效改善患者预后,保障患者的用药安全。     

临床药师参与1例厌氧消化链球菌感染 产妇治疗的药学实践

药师从药物选择、疗程控制等方面参与1例起初被误诊和确诊后病情反复的厌氧消化链球菌感染产妇的药物治疗过程,产妇感染得到控制后出院。     

临床药师参与1例肾移植术后合并复杂感染患者个体化治疗的药学实践

目的 以1例肾移植术后合并复杂感染患者为例,探讨临床药师在肾移植术后患者个体化药物治疗和合理用药中的作用.方法 临床药师全程参与1例肾移植术后合并结核及耐碳青霉烯的肺炎克雷伯菌(CRKP)复杂感染患者的诊疗过程,通过多学科会诊、联合查房、密切用药监护等多维模式加入临床治疗团队,提供个体化药学服务.结果 临床药师协助医生...     

临床药师参与1例腹膜透析合并重症肺炎治疗的药学实践

摘 要 目的：探讨临床药师在慢性肾功能不全合并肺部重症感染患者救治团队中的作用。方法: 临床药师参与1例腹膜透析患者的抗感染治疗方案讨论、制定与调整,并为患者提供个体化全程药学监护。结果: 在治疗过程中,临床药师建议加用利奈唑胺抗革兰阳性菌治疗,同时考虑长疗程使用广谱抗菌药物可增加二重感染风险,与医师共同为患者制定了头孢哌酮/舒巴坦作为降阶梯治疗方案,并为患者确定了具体的给药间隔,患者病情得到有效控制后好转出院。结论:全程药学监护有助于提高临床用药的合理性、安全性及有效性。     

Non-antibiotic strategies for the prevention/treatment of Clostridium difficile infection

Background: Clostridium difficile infection has become a serious concern in both hospital and secondary healthcare environments. In the presence of repeated or prolonged antibiotic treatment, the C. difficile spores can germinate in the colon and produce toxins that cause colonic inflammation and diarrhea. The standard treatment for C. difficile-associated disease (CDAD) usually involves the withdrawal of the antibiotic treatment that led to the CDAD followed by a course of oral metronidazole or vancomycin, but there has been an increasing number of treatment failures and recurrences of disease. Over the past 10 – 15 years, researchers have begun exploring the possibility of using alternative means to combat C. difficile infection. Objective/methods: Over the course of the past 5 years, there has been a considerable amount of patent literature focused on non-antibiotic alternatives, including passive and active immunizations, monoclonal antibodies, antitoxins, inert binders and probiotic therapies. Results/conclusion: Current antibiotic therapies for the treatment of CDAD are not as effective as they once were. There is some promising work on non-antibiotic alternatives for CDAD prevention and treatment.     

Clostridium difficile infection in children: a comprehensive review

Abstract

Objective:

To provide a comprehensive review of the literature relating to Clostridium difficile (C. difficile) infection (CDI) in the pediatric population.     

Future novel therapeutic agents for Clostridium difficile infection

Importance of the field: Clostridium difficile is the most important definable cause of healthcare acquired diarrhea. The increasing incidence and mortality associated with this enteric pathogen and the significant rate of treatment failures and recurrences with current antibiotics emphasize the need for the discovery of new and improved therapeutic and preventative agents.

What the reader will gain: We review upcoming novel therapeutic agents and the clinical evidence to support their efficacy in treating C. difficile infection. We also provide an extensive comparison of antimicrobial susceptibilities of C. difficile based on in vitro susceptibilities published in the literature.

Areas covered in this review: This review was conducted by a thorough examination of the public sources, including journals and scientific meeting abstracts, up to February 2009.

Take home message: A number of new therapeutic agents are in development and being tested in clinical trials. However, high costs and concerns for resistance may limit the use of these antimicrobials for the treatment of C. difficile infection. Passive and active immunotherapy may have important future roles as therapeutic and preventative strategies for C. difficile infection.     

Clinical review of Clostridium difficile infection: an update on treatment and prevention

ABSTRACT

Introduction: Clostridium difficile infection (CDI) has become a significant healthcare-associated infection and is strongly associated with antibiotic use. Practice guidelines have recently been revised incorporating updated recommendations for diagnosis, treatment, and prevention.

Areas covered: This review discusses updated aspects of CDI management. New and emerging pharmacologic options for treatment and prevention are reviewed.

Expert opinion: Metronidazole is associated with lower rates of treatment success compared to vancomycin and should no longer be used as primary therapy for the first episode of CDI or recurrent disease. Vancomycin or fidaxomicin are now recommended for first-line therapy for most cases of CDI. Fecal microbiota transplant is effective and safe for the treatment of recurrent CDI. Evidence supports the use of fidaxomicin and bezlotoxumab for prevention of recurrent CDI; however, the costs associated with these therapies may limit their use. Validated risk prediction tools are needed to identify patients most likely to benefit from these treatments. Future advancements in microbiota targeting treatments will emerge as promising alternatives to standard CDI treatments. Antibiotic stewardship and infection control measures will remain essential components for CDI management.     

内分泌临床药师参与慢病管理的实践和体会

目的：探索临床药师开展慢病患者管理的工作模式。方法：临床药师以参与内分泌科临床实践和临床药师规范化培训带教实践为切入点,通过参与医疗查房、开展药学查房,审核用药医嘱,协同临床医生制定药物治疗方案,多种形式指导患者用药,建立“以患者为中心”的药学服务模式。结果：通过积极有效的沟通,医生能很好地采纳药师建议,从而减少药品不良反应的发生,提高药物治疗的有效性;通过多种形式的用药教育模式,改善了患者的用药依从性。结论：内分泌科临床药师发挥主观能动性,积极参与临床实践,在糖尿病慢病管理中具有举足轻重的地位和作用。     

Fidaxomicin (OPT-80) for the treatment of Clostridium difficile infection

Importance of the field: Clostridium difficile infection (CDI) has become an increasingly important healthcare-associated complication in many countries. CDI outbreaks, a new ‘hypervirulent’ form and increased worldwide rates have underscored four urgent unmet needs for this disease: i) effective prevention of CDI; ii) therapies to produce faster resolution of CDI symptoms; iii) therapies to treat severe CDI more effectively and reduce its mortality; and iv) therapies to reduce the CDI recurrence rate following treatment.

Areas covered in this review: Fidaxomicin, a new macrocyclic antibiotic, has demonstrated potent in vitro activity against C. difficile with limited or no activity against normal fecal flora. It is minimally absorbed from the intestinal tract, even in the presence of intestinal inflammation. When tested against oral vancomycin in clinical studies of CDI therapy, it has equivalent efficacy for curing CDI at end of treatment and a comparable safety profile to that agent. However, fidaxomicin therapy of CDI is associated with significantly fewer CDI recurrences in the 28 days following treatment. Symptom resolution is also slightly quicker in some CDI patients. Additional fecal flora analysis in the CDI trials showed that fewer individuals developed intestinal colonization with vancomycin-resistant enterococci (VRE) among the fidaxomicin-treated group. This new molecule, which has just completed two large Phase III multicenter studies, successfully addresses two of the four urgent and unmet needs for dealing with CDI.

What the reader will gain: Fidaxomicin is as effective and as safe as vancomycin therapy for treating CDI but is associated with far fewer recurrences post-treatment and a decreased risk of VRE acquisition.

Take home message: Fidaxomicin is a potential new therapy for CDI which has the capacity to substantially decrease post-treatment recurrences and is as safe and well-tolerated as standard vancomycin treatment.     

Clostridium difficile antibodies: a patent evaluation (WO2013028810)

Introduction: Incidence and severity of Clostridium difficile infection (CDI) are increasing worldwide. Toxins A (TcdA) and B (TcdB) and host immune response are the major determinates of CD pathogenesis and represent a new, stimulating therapeutic target to control CDI.

Areas covered: The present patent and literature on the pathogenesis and treatment of CD were critically reviewed. The patent was described and put into clinical context, highlighting possible advantages and barriers to use. It consists of a blend of monoclonal antibodies (mAbs) and antigen-binding portions that neutralize TcdA, targeting the enterocyte-binding domain. It demonstrated good efficacy in in vivo models and seems promising in clinical practice. However, recent evidence reshaped the central role of TcdA.

Expert opinion: Current treatments are inadequate to control CDI and recurrence. Toxin-targeted mAbs are one of the most promising approaches for CDI, including infection by hypervirulent strains. At-risk subjects and those experiencing recurrence are the ideal targets for this second-line treatment; however CDI epidemiology is fast-changing and mAbs may represent a powerful option also for other patients. The re-evaluation of the pathogenic role of TcdA may potentially limit the use of this product; however, the possible administration in combination with other therapeutic agents may optimize its efficacy.     

临床药师对1例肺部感染合并癫痫患者的药学监护

目的探讨临床药师在对肺部感染且合并癫痫患者的药学监护点,促进临床合理用药。方法通过对1例主诉发热合并癫痫患者的用药过程,对抗菌药物、保肝药物、抑酸药物、糖皮质激素、抗癫痫药的应用进行药学监护,提出用药注意事项,并建议医师及时换药。结果临床药师深入临床,直接为医师、护士及患者提供药学服务,可有效提高药物的治疗效果,减少药物的不良反应。结论通过参加临床实践,临床药师为合理用药提供了帮助,使患者得到了更好的药学服务。     

Cadazolid for the treatment of Clostridium difficile

Introduction: Antibiotic development goals for CDI include potent antimicrobial effect against C. difficile, limited killing of host microbiota, potential effect on spores, and ability to interfere with toxin production. Cadazolid, a novel, non-absorbable hybrid antibiotic has many of these criteria. In phase I and II clinical trials, cadazolid was shown to be safe, well tolerated, and efficacious positioning itself as a potential future viable therapeutic option for CDI.

Areas covered: This review provides an in-depth evaluation of the chemistry, microbiology, pharmacodynamics, pharmacokinetics, and clinical trial results for cadazolid. Clinical therapeutic outcomes are compared between cadazolid, fidaxomicin, and surotomycin.

Expert opinion: Preclinical and early clinical studies demonstrated that cadazolid has unique properties that will likely be valuable to treat CDI and reduce recurrent infection. With compelling phase II clinical results, results from the ongoing phase III trial will better define the role of cadazolid for treating CDI in the future.     

Rethinking Strategies to Select Antibiotic Therapy in Clostridium difficile infection

In recent years, Clostridium difficile infection (CDI) has become a global public health threat associated with increased morbidity, mortality, and economic burden, all of which are exacerbated with disease recurrence. Current guidelines informing treatment decisions are largely based on definitions of disease severity at diagnosis, with subjective components not well delineated across treatment algorithms and clinical trials. Furthermore, there is little evidence linking severity at onset to outcome. However, reducing the risk of recurrence may offer both a better outcome for the individual and decreased downstream economic impact. The authors present data supporting the opinion that patients deemed at low risk for recurrence should receive vancomycin (or metronidazole when cost is an issue), while those at higher risk of recurrence would benefit from fidaxomicin treatment. Although further prospective studies are needed, choosing treatment with the goal of preventing recurrent CDI may offer a better guide than disease severity.