临床药师参与1例播散性格特隐球菌感染患者长期治疗的药学监护实践OA

OBJECTIVE To provide guidance for pharmaceutical care in patients with severe Cryptococcus gattii infections.METHODS Clinical pharmacists participated in the diagnosis and treatment of a male patient with disseminated Cryptococcus gattii infection(involving the lungs and central nervous system).Given the patient's poor response to initial therapy,the clinical pharmacists,based on antimicrobial susceptibility test results,recommended voriconazole as an alternative azole.In response to refractory hypokalemia caused by liposomal amphotericin B,the clinical pharmacists assisted the physician in developing an intensive potassium replacement regimen.Regarding the interaction between voriconazole and nifedipine,the clinical pharmacists proactively identified the risk and intensified monitoring of the patient's blood pressure.In response to the onset of hepatitis C during treatment,the clinical pharmacists thoroughly weighed the priority of infection treatment and recommended temporarily postponing antiviral therapy for hepatitis C.For the individualized use of voriconazole,the clinical pharmacists repeatedly performed therapeutic drug monitoring(TDM).Regarding the patient's poor lesion resolution,the clinical pharmacists participated in multidisciplinary team discussions to clarify the indications for surgery.RESULTS The physician adopted the clinical pharmacists'recommendations.Following pharmacological treatment and surgical intervention,the patient's condition stabilized,and he was discharged while still on medication.CONCLUSIONS For severe Cryptococcus gattii infections,clinical pharmacists should focus on pathogen characteristics,strengthen adverse reaction management,pay close attention to drug interactions,conduct TDM,and actively participate in multidisciplinary team collaboration to ensure the safety and efficacy of patient treatment.