1例伯基特淋巴瘤患儿化疗后手部皮肤软组织感染治疗方案的优化分析

Optimization and Analysis of Treatment Program for a Burkitt Lymphoma Pediatric Patient with Hand Skin and Soft Tissue Infection After Chemotherapy

关键词:  伯基特淋巴瘤  皮肤软组织感染  抗菌药物  合理用药

Key words:  burkitt lymphoma  skin and soft tissue infection  antibiotics  rational drug use

摘要:

目的 为伯基特淋巴瘤化疗后手部皮肤软组织感染（skin and soft tissue infection，SSTI）患儿的抗感染治疗提供思路和方法。方法 临床药师对济南市儿童医院收治的1例伯基特淋巴瘤化疗后手部SSTI患儿的抗感染方案进行优化，针对该患儿可能存在的耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus，MRSA）感染的初始抗菌药物的选择、后续药物更换，治疗过程中出现严重粒细胞缺乏状态时抗菌药物的选用及哌拉西林他唑巴坦的剂量调整、替考拉宁频次确定等方面提出建议。结果 考虑为MRSA感染时首先选用利奈唑胺，之后根据血小板水平更换为替考拉宁，并确定其频次为前3剂160 mg，输液泵输，q12h，随后剂量为160 mg，输液泵输，qd；当患儿处于严重粒细胞缺乏状态时，选用亚胺培南西司他丁钠及米卡芬净抗感染治疗；根据指南和药动学/药效学理论，调整哌拉西林他唑巴坦剂量为1.2 g，ivgtt，q8h至1.8 g，ivgtt，q8h，并延长其输注时间至3 h。医师采纳上述建议。患儿经积极有效的抗感染、对症支持等治疗后，症状体征明显好转，病情稳定予以出院。结论 临床药师在参与血液肿瘤合并感染的治疗过程中，可以根据患儿的具体病情变化制订个体化治疗方案，提出合理化用药建议。

Abstract:

OBJECTIVE To provide methods and ideas for anti-infection treatment of a burkitt lymphoma child patient with hand skin and soft tissue infection(SSTI) after chemotherapy. METHODS The clinical pharmacist optimized the anti-infection regimen of a burkitt lymphoma child patient with hand SSTI admitted to Children's Hospital of Jinan, the choice of initial antibiotics and the replacement of drugs follow-up aiming at the child's infection of methicillin-resistant Staphylococcus aureus(MRSA), in the process of treatment, the selection of antibiotics in severe agranulocytosis state, the dose adjustments of piperacillin tazobactam, and the frequency determination of teicoplanin were proposed. RESULTS When considering MRSA infection, linezolid was firstly selected, and then replaced with teicoplanin a ccording to the platelet level, and the frequency was determined as the first three doses of 160 mg, infusion pump, q12h, followed by the dose of 160 mg, infusion pump, qd. When the pediatric patients in the state of severe agranulocytosis, imipenem and cilastatin sodium and micafungin were used for anti-infection treatment. According to the guidelines and pharmacokinetic/pharmacodynamic theory, the dose of piperacillin tazobactam was adjusted from 1.2 g, ivgtt, q8h to 1.8 g, ivgtt, q8h, and the infusion time was extended to 3 h. The physician adopted the above recommendations. After effective anti-infection and symptomatic treatment, the symptoms and signs of the pediatric patients were significantly improved, and the pediatric patients was discharged with stable condition. CONCLUSION Participating in the treatment of a child patient with hematological malignancy complicated with infection, clinical pharmacists can make the individual treatment plans according to the specific changes of the disease, put forward the r ational medication suggestions.