Page 104 - 《中国药房》2023年16期

·药师与药学服务·

1 例玛尔摩分枝杆菌致中枢神经系统感染合并药物性肝损伤的
药学实践
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2 #
1＊
赖 舒 ，阮 一 ，何 瑶 （1.重庆市九龙坡区人民医院药剂科，重庆 400050；2.重庆大学附属中心医院
2
药剂科，重庆 400014）
中图分类号 R969.3；R378.91 文献标志码 A 文章编号 1001-0408（2023）16-2014-04
DOI 10.6039/j.issn.1001-0408.2023.16.18

摘 要 目的 介绍1例玛尔摩分枝杆菌致中枢神经系统感染合并药物性肝损伤患者的药物诊疗方案和相关药学监护，为临床药
师开展药学实践提供借鉴。方法 临床药师参与 1 例玛尔摩分枝杆菌致中枢神经系统感染合并药物性肝损伤患者的治疗过程。
考虑到患者头痛加剧，皮肤再次出现红斑，临床药师建议停用异烟肼，将治疗方案调整为利福平胶囊+盐酸乙胺丁醇片+硫酸阿米
卡星注射液+克拉霉素片四联抗感染，并建议送脑脊液样本行二代基因测序以明确病原菌；待确认病原菌为玛尔摩分枝杆菌后，临
床药师建议维持上述四联方案治疗；当患者出现药物性肝损伤后，临床药师协助医师调整用药方案，以盐酸莫西沙星片替代利福
平胶囊，予谷胱甘肽片保肝治疗，并行肝肾功能、心电图监测。结果与结论 医师采纳临床药师的建议；患者病情好转，准予出院。
临床药师通过追踪患者的病史和用药史，查阅指南/共识、研究报道等文献资料，结合患者病情和药物作用特点，分析不良反应发
生原因，及时调整抗感染药物治疗方案并针对不良反应进行对症处理，从药学角度协助医师完善了临床治疗决策，保证了临床用
药的有效性、安全性。
关键词 玛尔摩分枝杆菌；中枢神经系统感染；药物性肝损伤；临床药师；药学实践

Pharmaceutical practice for one case of central nervous system infection caused by Mycobacterium
malmoense combined with drug-induced liver injury
LAI Shu ，RUAN Yi ，HE Yao（1. Dept. of Pharmacy，Jiulongpo District People’s Hospital of Chongqing，
2
1
2
Chongqing 400050，China；2. Dept. of Pharmacy，the Affiliated Central Hospital of Chongqing University，
Chongqing 400014，China）
ABSTRACT OBJECTIVE To introduce the drug diagnosis， treatment plan and pharmaceutical care of a case of central nervous
system infection caused by Mycobacterium malmoense combined with drug-induced liver injury， and to provide a reference for
clinical pharmacists to carry out pharmaceutical practice. METHODS Clinical pharmacists participated in the whole treatment of a
case of central nervous system infection caused by M. malmoense combined with drug-induced liver injury. Considering the
patient’s headache worsened and the skin appeared red spot again， clinical pharmacists suggested stopping isoniazid and adjusted
the quadruple anti-infection regimen to Rifampicin capsules+Ethambutol hydrochloride tablets+Amikacin sulfate injection+
Clarithromycin tablets， and sending cerebrospinal fluid samples for the next-generation sequencing to identify the pathogen. After
the pathogen was identified as M. malmoense， clinical pharmacists recommend continuing the above quadruple regimen. When the
patient suffered from drug-induced liver injury， clinical pharmacists assisted physicians to adjust the medication plan， and suggested
that Rifampicin capsules should be discontinued， Moxifloxacin hydrochloride tablets should be used for anti-infection treatment，
Glutathione tablets should be used for liver protection treatment， and renal function and electrocardiogram monitoring should be
performed. RESULTS & CONCLUSIONS The physicians adopted the advice of clinical pharmacists， and the patient was
discharged after the condition improved. Clinical pharmacists review the patient’s medical and medication history， consult
guidelines/consensus， research reports， and other literature materials， analyze the causes of adverse reactions based on the patient’s
condition and the characteristics of drug action， adjust the medication plan of anti-infective drugs in a timely manner， and provide
targeted treatment for adverse reactions. From a pharmaceutical perspective， they assist physicians in improving clinical treatment
decisions and ensuring the efficacy and safety of clinical
Δ 基金项目 重庆市科卫联合医学科研项目（No.2023MSXM090）
＊第一作者 主管药师，硕士。研究方向：临床药学、药理学、医院 medication.
药事管理。E-mail：672305465@ qq.com KEYWORDS Mycobacterium malmoense； central nervous
# 通信作者 副主任药师，硕士。研究方向：临床药学、药理学、医 system infection； drug-induced liver injury； clinical phama-
院药事管理。E-mail：27382552@qq.com cists； pharmaceutical practice

· 2014 · China Pharmacy 2023 Vol. 34 No. 16 中国药房 2023年第34卷第16期