SHI Juan, HAN Jin-cai, SHI Guang-wei, YANG He, ZENG Jun-yuan, YANG Yan-mei
Objective: To analyze the anti-infective therapy and pharmaceutical care process of a patient with liver abscess complicated by pulmonary infection, and provide a reference for the clinical treatment of such patients. Methods and Results: A patient was admitted with headache, generalized soreness, cough and expectoration, nausea, vomiting, abdominal pain, high fever and chills. The admitting diagnoses were ''pulmonary infection'' and ''acute bronchitis'', and cefotaxime sodium was used for initial anti-infective therapy. As the infection continued to aggravate during treatment, the medication was adjusted to cefoperazone-sulbactam sodium (cefoperazone: sulbactam = 1:1, 3 g, q12h, intravenous infusion) after pharmacist consultation. On the 5th day of admission, the patient's symptoms still did not improve and infection indicators increased; after communication between pharmacists and physicians, the anti-infective therapeutic regimen was adjusted to cefoperazone-sulbactam sodium (cefoperazone: sulbactam = 2:1, 3 g, q8h, intravenous infusion) plus levofloxacin injection. On the 8th day of admission, the patient suffered from severe epigastric pain. Contrast-enhanced abdominal CT revealed a space-occupying lesion in the left hepatic lobe, highly suggestive of liver abscess. The clinical diagnosis of ''liver abscess'' was added, and percutaneous puncture and catheter drainage of the liver abscess was performed on the same day, without adjustment of the anti-infective therapeutic regimen. On the 13th day of admission, the patient developed bitter mouth, dry mouth, abdominal distension, abdominal pain, chest tightness and shortness of breath, and was given domperidone tablets, phloroglucinol injection and Zhichuanling Injection for symptomatic treatment. On the first day of this treatment, the patient presented with involuntary hand movement, restlessness, hallucination and impulsive behavior. After correlation analysis of adverse drug reactions, the pharmacist recommended discontinuing domperidone tablets, Zhichuanling Injection and levofloxacin and sodium chloride injection; the neurological symptoms resolved completely after drug withdrawal. On the 22nd day of admission, the patient's symptoms and laboratory findings improved significantly, and discharge was approved. The clinical pharmacist provided discharge medication advice, recommending amoxicillin-clavulanate potassium tablets plus metronidazole tablets. Conclusion: Through participation in the treatment and medication monitoring of a patient with liver abscess complicated by pulmonary infection, clinical pharmacists have adjusted anti-infective agents, identified and managed adverse drug reactions in a timely manner, thereby improving therapeutic efficacy and ensuring medication safety.
