临床药师对1例青霉素过敏的坏死性筋膜炎合并糖尿病患者的药学实践

目的:探讨1例青霉素过敏的坏死性筋膜炎合并糖尿病患者治疗方案的制定和相关药学监护。方法:2018年3月30日鄂尔多斯市中心医院收治1例青霉素过敏的坏死性筋膜炎合并糖尿病患者,临床药师根据患者自身疾病特点从抗感染治疗用药选择、坏死性筋膜炎监护要点、血糖监测及低蛋白血症对抗菌药物药动学-药效学的影响等方面在其治疗过程中开展药学监护,协助医师制订合理有效的个体化治疗方案。结果:针对患者糖尿病,先后采用赖脯胰岛素注射液(胰岛素泵)、阿卡波糖片、盐酸二甲双胍片、格列美脲片进行降糖治疗;针对患者快速心房颤动伴室内差异性传导和ST-T改变,采用酒石酸美托洛尔片进行降心率治疗;针对患者坏死性筋膜炎,临床药师考虑到患者有青霉素过敏史及低蛋白血症,选择药物时在保证抗感染疗效的同时尽量选择与青霉素母核和侧链不同且其蛋白结合率相对较低的药物,先后采用注射用亚胺培南西司他丁注射液、注射用氨曲南、乳酸左氧氟沙星氯化钠注射液进行抗感染治疗,注射用伏立康唑进行抗真菌治疗。医师采纳临床药师的建议,通过早期彻底引流清创以及合理用药治疗,该患者病情得到有效控制。结论:临床药师协助医师制订及优化本例患者全程治疗方案,提高了药物治疗的安全性和有效性。

Pharmaceutical Practice of Clinical Pharmacist Participating in a Penicillin Allergic Patient with Necrotizing Fasciitis Combined with Diabetes Mellitus

OBJECTIVE:To investigate the formulation of therapy plan and pharmaceutical care for a penicillin allergic patient with necrotizing fasciitis combined with diabetes mellitus.METHODS:A penicillin allergic patient with necrotizing fasciitis combined with diabetes mellitus was admitted to Ordos central hospital on March 30,2018.According to the disease characteristics of the patient,clinical pharmacists conducted pharmaceutical care during the treatment process from the aspects of antiinfective drugs selection,monitoring points of necrotizing fasciitis,blood glucose monitoring,effects of hypoproteinemia on antibiotic pharmacokinetics-pharmacodynamics,and assisted the physician to develop a more reasonable and effective individualized therapentic regimen.RESULTS:For diabetes mellitus,the patient adjusted Insulin lispro injection(insulin pump),Acarbose tablets,Metformin hydrochloride tablets and Glimepiride tablets successively.For rapid atrial fibrillation with intraventricular differential conduction and ST-T changes,Metoprolol tartrate tablets were used to reduce heart rate.For necrotizing fasciitis,when choosing drugs to ensure the anti-infective effect,considering that the patient had penicillin allergic and hypoproteinemia,clinical pharmacists chose drugs with low protein binding rates and different from the mother nucleus and side chain of penicillin.Imipenem cilastatin for injection,Aztreonam for injection,Levofloxacin lactate and sodium chloride injection were used successively.Voriconazole for injection was adopted for anti-fungal treatment.Physicians adopted the suggestions of clinical pharmacists.Debridement through early thorough drainage and rational drug use,the patient’s condition was effectively controlled.CONCLUSIONS:Clinical pharmacists assist physicians to formulate and optimize whole course therapentic regimen so as to improve the safety and effectiveness of drug treatment.