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临床药师对1例脑卒中后肺部感染的肥胖患者抗感染治疗方案的优化
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| 篇名： | 临床药师对1例脑卒中后肺部感染的肥胖患者抗感染治疗方案的优化 |
| TITLE： | |
| 摘要： | 目的：为脑卒中后肺部感染的肥胖患者的抗感染治疗提供治疗方法和思路方案。方法：临床药师对我院收治的1例脑卒中后肺部感染肥胖患者（BMI＝34.602 kg/m2）的抗感染方案进行优化，针对该肥胖患者的哌拉西林他唑巴坦的剂量调整、药物更换，以及抗耐甲氧西林金黄色葡萄球菌（MRSA）药物的选择和剂量确定等方面提出建议。结果：根据患者体质量和指南，调整哌拉西林他唑巴坦剂量自4.5 g，q12 h至4.5 g，q6 h；在因病原变化更换抗菌药物为莫西沙星时，确认剂量为0.4 g，qd，无需加量；确诊为MRSA感染导致的肺炎时，选用利奈唑胺而非万古霉素进行肥胖患者的感染治疗，并确定剂量为600 mg，q12 h。医师采纳上述建议。患者经治疗后体温下降，咳嗽、咳痰缓解，实验室指标恢复正常后顺利出院。结论：肥胖患者在使用抗菌药物治疗前，临床药师应评估患者的肥胖程度、肝肾功能，再结合药物自身特性，协助医师合理地选择药物并调整给药剂量，在保证疗效的同时避免不良反应。 |
| ABSTRACT： | OBJECTIVE： To explore the methods and ideas for clinical pharmacists to optimize anti-infective treatment programs in obese patients with pulmonary infection. METHODS： The clinical pharmacist optimized the anti-infection regimen of an obese patient with post-stroke pulmonary infection （BMI＝34.602 kg/m2） admitted to our hospital， and adjusted the dose adjustment and drug replacement of piperacillin tazobactam in the obese patient. And the selection of methicillin-resistant Staphylococcus aureus （MRSA） drugs and dose determination were proposed. RESULTS： According to the patient’s body weight and guidelines， the dose of piperacillin tazobactam was adjusted from 4.5 g， q12 h to 4.5 g， q6 h； the antibiotic was changed to moxifloxacin due to pathogenic changes， the dose was 0.4 g， qd， no need to increase When diagnosed as pneumonia caused by MRSA infection， linezolid was used instead of vancomycin for infection treatment in obese patients， and the dose was determined to be 600 mg， q12 h. The physician adopted the above recommendations. After treatment， the patient’s temperature decreased， cough and sputum eased， and the laboratory indicators returned to normal and discharged smoothly. CONCLUSION： Clinical pharmacists can participate in the drug treatment of special obese patients by exerting their own professional advantages： by adjusting the type， dose and frequency of antibacterial drugs， patients can obtain individualized treatment， improve the safety and effectiveness of patients’ medication， and finally obtain satisfactory results. |
| 期刊： | 2019年第30卷第17期 |
| 作者： | 蒋为薇，钱妍 |
| AUTHORS： | JIANG Weiwei，QIAN Yan |
| 关键字： | 肥胖；抗感染；抗菌药物；合理用药 |
| KEYWORDS： | Obesity； Anti-infection； Antibiotics； Rational drug use |
| 阅读数： | 293 次 |
| 本月下载数： | 8 次 |
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