1例老年肺部感染患者的药学监护

1例78岁老年男性患者，因发热2d入院，既往合并系统性血管炎、高血压、肝功能损伤。入院后给予美罗培南、莫西沙星抗感染、醋酸泼尼松龙控制血管炎及降压、保肝等治疗。临床药师评估其初始治疗方案，并持续关注其药物治疗，对患者进行全程药学监护，在发生替考拉宁相关肾损伤、抗生素相关大疱性皮肤反应及药物相关肝损伤时进行及时的用药分析，与医生充分沟通并建议停用替考拉宁、莫西沙星、夫西地酸等相关可疑药物，患者病情稳定，治疗32d出院。

Pharmaceutical care on an old patient with pulmonary infection

One 78-year-old male patient was admitted to hospital due to fever for two days with systemic vasculitis, hypertention and hepatic insufficiency. After admission, several treatments were given to him including anti-infection therapy with meropenem and moxifloxacin, anti-vasculitis therapy with prednisolone acetate, anti-hypertention therapy, liver protection therapy and so on. The initial antibiotics regime and the continuing hospital medication were evaluated by clinical pharmacist and the whole- range pharmaceutical care was carried out. Timely medication analysis and suggestions involving teicoplanin-related renal injury, antibiotic-related epidermolysis bullosa and antibiotic-related hepatic injury were given to physician.Teicoplanin, moxifloxacin and fusidic acid were discontinued for suspicious drug-related ADRs. The patient was in stable situation and he was discharged from hospital on the thirty-second day.