临床药师参与1例皮肌炎合并马尔尼菲篮状菌膝关节感染的药学实践

目的 为皮肌炎合并马尔尼菲篮状菌(talaromycosismarneffei,TM)关节感染患者的诊疗提供精准治疗。方法 临床药师全程参与此例患者的诊疗，提供药物治疗方案选择、药物相互作用、血药浓度监测和不良反应监护等药学服务。结果 患者经伏立康唑治疗序贯伊曲康唑治疗，并随访4个月，他克莫司和伏立康唑的血药浓度均在目标治疗范围内，临床症状明显改善，未发生严重不良反应。结论 临床药师参与皮肌炎并TM感染的个体化治疗，促进临床合理用药。

Pharmaceutical Practice of Clinical Pharmacists Participated in A Patient with Dermatomyositis and Knee Joint Infection Caused by Talaromycosis Marneffei

ABSTRACT: OBJECTIVE To provide precise treatment for the patient with dermatomyositis and knee joint infection caused by TM. METHODS Clinical pharmacists participated fully in the treatment of this patient, providing pharmaceutical care in terms of choices about treatment options, drug interactions, therapeutic drug monitoring and adverse reaction monitoring. RESULTS After treatment of voriconazole followed by itraconazole, the blood concentrations of tacrolimus and voriconazole were within the target treatment range during four month follow-up, and the clinical symptoms were significantly improved without serious adverse reactions. CONCLUSION The participation of clinical pharmacists in the formulation of individual medication plan of a patient with dermatomyositis and knee joint infection caused by TM, which promotes rational clinical drug use.