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细菌性脑膜炎是儿童时期常见的中枢神经系统急性感染性疾病,其病情重、进展快,病死率较高,即使治愈后常伴有不同程度的神经系统后遗症[1]。其最常见的病原菌是脑膜炎球菌、金黄色葡萄球菌和肺炎链球菌等。有效的抗菌药物治疗是细菌性脑膜炎治疗成功的关键,结合最新指南建议,规范临床用药,为患儿提供个体化治疗是临床药师关注的重点。本文通过对1例细菌性脑膜炎的个体化抗感染,对其药物治疗进行分析,为此类疾病的诊断和治疗提供参考。
Treatment analysis and pharmaceutical care for one child with bacterial meningitis
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摘要:
目的 探讨儿童细菌性脑膜炎药物治疗及药学监护的策略。 方法 借助相关指南及文献,对1例儿童细菌性脑膜炎的抗感染治疗、万古霉素的血药浓度监测(TDM)和剂量调整进行分析及讨论,向临床医生提供药物治疗措施和建议。 结果 通过对儿童细菌性脑膜炎的用药分析,结合病原学及药敏结果停用美罗培南,加用利福平;根据万古霉素监测浓度,延长其输注时间以达目标范围,医生部分采纳临床药师建议,患者病情好转出院。 结论 临床药师应依据药物治疗相关指南及最新研究证据为临床提供用药建议,以促进临床用药合理有效。 Abstract:Objective To explore the strategies of drug treatment and pharmaceutical care for children with bacterial meningitis. Methods The anti-infective therapy, therapeutic drug monitoring and dose adjustment of vancomycin in children with bacterial meningitis were analyzed and discussed according to relevant guidelines and literatures. Results Clinical pharmacists analyzed therapeutic regimen. According to the results of etiology and drug sensitivity, meropenem was discontinued and rifampicin was added. Based on drug monitoring of vancomycin, it is suggested to extend the infusion time of vancomycin to reach the target concentration. The child was discharged from hospital. Conclusion Recommendations of the relevant drug treatment guidelines and the latest medical research evidence should be provided by clinical pharmacists in order to promote reasonable and effective clinical uses of medicine. -
Key words:
- bacterial meningitis /
- anti-infection /
- therapeutic drug monitoring /
- pharmaceutical care /
- children
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