临床药师对1例糖尿病足伴发感染患者的药学监护

目的:探讨老年糖尿病足的个体化药学监护。方法:在未获得细菌培养及药敏试验结果前,主管医师与临床药师根据病例特点、细菌耐药监测以及相关指南对患者进行评估,药师建议选择美罗培南1 g、q12h联合克林霉素0.6 g、q12h抗感染治疗;患者出现抗生素相关性腹泻,临床药师建议停用克林霉素,口服甲硝唑200 mg、tid,加用肠道菌群调节剂枯草杆菌二联活菌肠溶胶囊扶植肠道正常菌群。结果:患者糖尿病足伴发感染的药物治疗有效、合理,临床药师及时发现和解决了患者药物治疗的问题,为临床合理用药提供了意见。结论:临床药师在对糖尿病足伴发感染的老年患者监护中,不仅要关注降糖、降压、调脂、抗感染等药物治疗方案的制订和评价,也要了解低血糖的防治、持续负压封闭引流、康复治疗等非药物治疗内容。

Pharmaceutical Care for a Patient with Diabetic Foot Infection by Clinical Pharmacists

OBJECTIVE： To discuss individualized pharmaceutical care for the elderly diabetic foot disease. METHODS： Be- fore bacterial culture and drug sensitivity test, the physicians and clinical pharmacists evaluated the patient according to characteris- tics of medical case, drug resistance monitoring and related guideline; clinical pharmacists suggested to use meropenem 1 g, ql2h, combined with clindamycin 0.6 g, q12h. Then the patient suffered from antibiotic-related diarrhea, clinical pharmacists suggested to stop taking clindamycin but use metronidazole 200 mg, tid, and culture intestinal flora using intestinal flora regulator Bacillus subti- lis diplo viable organism enteric capsule. RESULTS： Drug treatment was effective and reasonable for diabetic foot disease compli- cated with infection. The clinical pharmacist could timely identify and solve the problems of drug therapy in order to provide sugges- tions for rational drug use. CONCLUSIONS： Clinical pharmacists not only pay attention to the formulation and evaluation of drug therapy for hyperglycaemia, hypertension, hyperlipemia and infection, but also investigate the prevention of hypoglycemia, PVF acuum sealing drainage, rehabilitation, etc.