1例肝功能异常伴感染患者药疹治疗方案的优化

目的 探讨1例肝功能异常伴感染患者出现药疹时，如何判断药疹、优化抗组胺药物及糖皮质激素的使用。方法 结合患者肝肾功能及血常规、治疗药物、过敏史等情况，通过查阅药疹诊疗文献、抗组胺药物使用说明书及糖皮质激素指导原则，从药物联用、药物组成及制剂特点、抗组胺药的分类及各自代谢、排泄特点、患者感染控制和皮疹进展情况，明确引起药疹的药物并优化治疗方案。结果 临床药师建议加用氯苯那敏（肌注）+西替利嗪（口服），在皮疹仍控制不佳的情况下，建议加用地塞米松（静脉滴注），医师接受建议。结论 临床药师面对脏器功能异常伴感染患者发生药疹并进行药物治疗时，应综合分析疾病及药物特点，及时准确地提供药学建议。

Treatment optimization for dermatitis medicamentosa in a patient with abnormal liver function associated with infection

Objective To optimize the treatment plan for dermatitis medicamentosa in a patient with abnormal liver function associated with infection. Methods The culprit medication for drug eruption was identified by reviewing the patient''s liver and kidney function, routine blood count, therapeutic drugs, allergic history, by analyzing the characteristics of the compounding medication, combined with literature search on drug eruption diagnosis and treatments. Following the antihistamines and glucocorticoid use guidelines, the treatment plan was optimized by selecting appropriate antihistamines and glucocorticoids based on their metabolism and excretion pathway. Results The rash was poorly controlled after clinical pharmacist''s initial recommendation to use chlorpheniramine (intramuscular injection) and cetirizine (oral). The clinical pharmacist further suggested dexamethasone intravenous drip. The patient recovered well with the combination therapy of antihistamines and glucocorticoid. Conclusion When drug eruption occurred, clinical pharmacists should evaluate patient''s disease and medications comprehensively, provide timely and accurate pharmaceutical care to patients.