KANGGANRAN YAOXUE

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  • Multidimensional Mechanisms and Precision Therapeutic Management of Infection-Associated Thrombocytopenia*1
    ZHANG Lin-lin, LI Long-tu, WANG Xin, MA Liang, LI Yan, XIANG Qian, CUI Yi-min, LIU Zhi-yan
    2026, 23(6): 543-550. https://doi.org/10.13493/j.issn.1672-7878.2026.06-001
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    Grounded in the integrated framework of "infection-immunity-hematopoiesis", this article systematically elaborates the multidimensional pathological mechanisms and clinical management strategies of infection-related thrombocytopenia. Comprehensive analysis of recent research advancements reveals that this condition is a critical hematological phenotype of dysregulated systemic host responses, with distinct pathogen-specific nature. Its pathogenesis comprises multiple pathways, including suppressed bone marrow thrombopoiesis, immune/non-immune mediated peripheral platelet destruction, abnormal platelet distribution and programmed cell death, with cytokine storm as a central driver. The dynamic trend of platelet count represents a significant prognostic indicator. Accordingly, this article advocates a shift in clinical management from passive transfusion support to precision intervention based on mechanistic classification. Future research should prioritize dissecting key molecular interaction networks, developing rapid bedside diagnostic tools for subtyping, and advancing biomarker-guided adaptive targeted therapies, ultimately to improve patient prognosis.
  • Advances in Pharmaceutical Characteristics of Conventional and Liposomal Formulations of Amphotericin B
    WANG Pei-hong, ZHANG Yin
    2026, 23(6): 550-556. https://doi.org/10.13493/j.issn.1672-7878.2026.06-002
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    The morbidity and mortality of invasive fungal disease (IFD) remain high, representing a major challenge in clinical anti-infective therapy. Amphotericin B (AmB), a broad-spectrum and potent polyene antifungal agent, is the cornerstone of clinical treatment for severe IFD. The clinical application of amphotericin B deoxycholate (AmB-D) is greatly limited by its pronounced nephrotoxicity and narrow therapeutic window. To improve medication safety and expand the clinical application scope, alternative delivery systems with reduced toxicity have been developed. Current clinical evidence demonstrates that lipid-based formulations, particularly liposomal amphotericin B (L-AmB), significantly lower the risk of nephrotoxicity while preserving potent antifungal activity. Nevertheless, these formulations are constrained by high price, and their dosage regimens and dose-escalation regimens vary substantially across products. In clinical practice, individualized formulation selection and regimen design should be guided by the patient's infection type, organ function and economic status, to guarantee antifungal efficacy, minimize toxic and adverse reactions, and provide a reference basis for the standardized and rational use of AmB. This article systematically reviews marketed AmB formulations in China, and comparatively analyzes their differences in pharmaceutical properties, pharmacokinetic profiles, clinical dosage regimens, adverse drug reaction profiles and drug-drug interactions, so as to provide a reference for rational clinical selection and use of AmB formulations.
  • Anti‑infective Therapy and Pharmaceutical Care in a Child with Intra‑abdominal Infection and IgA Vasculitis Nephritis
    SUN Bang-yan, ZHAO Jing, LUO Sheng, LI Zheng-fu
    2026, 23(6): 557-562. https://doi.org/10.13493/j.issn.1672-7878.2026.06-003
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    Objective: To analyze the pharmaceutical care practice process of a child with abdominal infection complicated by IgA vasculitic nephritis, and to provide practical reference and conceptual guidance for the standardized pharmaceutical service model for pediatric patients with complex comorbidities. Methodsand Results: A 9-year-and-6-month-old boy was transferred to The First People's Hospital of Zhaotong on March 5, 2024 for abdominal infection following acute appendectomy. Empirical anti-infective therapy with cefoperazone-sulbactam sodium and symptomatic anti-allergy treatment were administered initially. The patient subsequently developed hypoalbuminemia and proteinuria, and was diagnosed with complicated abdominal infection and IgA vasculitic nephritis. Metronidazole and vancomycin were then added for combination anti-infective therapy. Vancomycin was discontinued due to suspected drug-related adverse reactions, and captopril was prescribed to reduce proteinuria. The patient later progressed to abdominal-type IgA vasculitis with gastrointestinal bleeding, and methylprednisolone was initiated for anti-inflammatory treatment. Considering the bleeding risk associated with cefoperazone-sulbactam sodium, clinical pharmacists recommended a regimen adjustment. As the patient's proteinuria worsened progressively and gastrointestinal bleeding recurred, the suggestion from pharmacists was adopted. The anti-infective regimen was switched to ceftazidime plus metronidazole, and mycophenolate mofetil was added for intensified immunosuppression. After infection control, antibacterial agents were discontinued, and calcium plus vitamin D supplementation was recommended by pharmacists to prevent glucocorticoid-induced osteoporosis. Finally, the patient's infection markers decreased, rash and gastrointestinal bleeding resolved, edema subsided, proteinuria markedly reduced, and organ damage was gradually repaired. He was discharged with medication after stabilization of the condition. Conclusion: IgA vasculitic nephritis is a common secondary glomerular disease in children, and cases complicated by post-appendectomy abdominal infection are relatively rare in clinical practice. For such patients, there are prominent therapeutic conflicts among anti-infection, immunosuppression and renal protection, with a high risk of overlapping adverse drug reactions and specific demands for pharmaceutical care. Deep integration of clinical pharmacists into the diagnostic and treatment process by optimizing dosage regimens at critical disease stages, implementing medication risk prevention and control and delivering stratified patient education, can facilitate individualized precision therapy, mitigate hidden risks of combination therapy, and comprehensively ensure medication safety and efficacy in pediatric patients.
  • Anti-infective Therapy and Pharmaceutical Care in a Patient with Cervical Spinal Abscess*1
    WEN Qin-qin, QIU Wen-zhen, ZHU Jin-hua, DING Yi-qiang
    2026, 23(6): 563-567. https://doi.org/10.13493/j.issn.1672-7878.2026.06-004
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    Objective: To analyze the anti-infective therapy and pharmaceutical care process of a patient with cervical spinal abscess complicated by polymicrobial infection, and to provide a reference for clinical diagnosis and treatment. Methodsand Results: A patient was admitted due to right shoulder pain and limited mobility, and showed no response to empirical therapy with cefoperazone-sulbactam sodium. Clinical pharmacists recommended switching to vancomycin combined with meropenem, and abscess drainage was performed. Intraoperative metagenomic next-generation sequencing detected Porphyromonas gingivalis, Campylobacter rectus and Filifactor alocis in the specimen. Vancomycin was then discontinued while meropenem was continued. After 10 additional days of treatment, the patient's symptoms and inflammatory markers improved. Clinical pharmacists further recommended switching to sequential therapy with levofloxacin (intravenous infusion) plus metronidazole (oral administration). The patient requested discharge after the condition improved gradually. The physician prescribed continued oral levofloxacin tablets after discharge and scheduled a follow-up reexamination 2 weeks later. Conclusion: In addition to the common pathogen Staphylococcus aureus, cervical spinal infections may be caused by other pathogenic bacteria. The involvement of clinical pharmacists in developing and adjusting individualized medication regimens is critical for successful treatment.
  • Anti-infective Therapy and Pharmaceutical Care in a Patient with Corynebacterium striatum Pneumonia
    MA Li, WU Yan, GAO Ting, XIONG Shi-juan
    2026, 23(6): 567-571. https://doi.org/10.13493/j.issn.1672-7878.2026.06-005
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    Objective: To analyze the anti-infective therapy and pharmaceutical care process of a patient with Corynebacterium striatum pneumonia, and to provide a reference for clinical medication and diagnosis of similar pulmonary infection cases. Methodsand Results: A patient was admitted due to "a 1-year history of cough and expectoration, accompanied by chest tightness and dyspnea for 3 months, with exacerbation for 3 days". Three months ago, targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF) performed at another hospital detected Escherichia coli, Mycobacterium abscessus and Enterococcus faecium. On admission, initial anti-infective therapy with piperacillin-tazobactam sodium was initiated. On Day 2 of admission, high-resolution chest CT revealed multiple inflammatory exudative lesions in both lungs, with new nodular cavitary lesions in the posterior basal segment of the right lower lobe. Piperacillin-tazobactam sodium was discontinued, and triple anti-infective therapy with azithromycin, imipenem-cilastatin sodium and linezolid (0.6 g, q24h, orally) was initiated based on sputum smear and culture results. After 6 days of the combination therapy, BALF tNGS confirmed the presence of Corynebacterium striatum. Combined with the patient's history of recurrent pulmonary infection, inflammatory markers and pulmonary imaging findings, clinical pharmacists identified the strain as the causative pathogen, recommended discontinuing azithromycin, and adjusted linezolid to "0.6 g, q12h". After 5 days of the adjusted regimen, follow-up chest CT showed absorption of inflammatory exudates and shrinkage of the cavitary nodule, indicating a good therapeutic response. Imipenem-cilastatin sodium was then discontinued, and the regimen was switched to moxifloxacin (0.4 g, q24h) plus linezolid (0.6 g, q12h) for anti-infective therapy. After 4 more days of treatment, the condition stabilized and the patient was discharged. Conclusion: Identification of the pathogenicity of Corynebacterium striatum, selection of appropriate anti-infective agents, and optimization of dosage and frequency are critical to the treatment outcome in patients with pulmonary infection.
  • Analysis of Diagnosis and Management of Drug‑Induced Immune Hemolytic Anemia Caused by Ceftizoxime Sodium and Biapenem in a Patient*1
    CHEN Ting-ting, HUANG Fan
    2026, 23(6): 572-576. https://doi.org/10.13493/j.issn.1672-7878.2026.06-006
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    Objective: To analyze the diagnosis and treatment process of adverse drug reactions in a patient with drug-induced immune hemolytic anemia caused by ceftizoxime plus biapenem, and to provide a reference for ensuring medication safety in special populations such as elderly patients with liver cirrhosis. Methodsand Results: A patient received ceftizoxime for anti-infective therapy due to spontaneous bacterial peritonitis. After treatment initiation, the patient's hemoglobin (Hb) level decreased progressively. The antibacterial agent was adjusted to biapenem, which led to a further decline in Hb, meeting the diagnostic criteria for severe anemia. The direct antiglobulin test (DAT) was positive, predominantly with IgG antibodies. Combined with clinical manifestations and medication history, the patient was diagnosed with drug-induced immune hemolytic anemia. The suspected drug biapenem was immediately discontinued, and dexamethasone was administered. A few days later, the patient's Hb level increased significantly and clinical symptoms improved rapidly. Conclusion: Ceftizoxime and biapenem are widely used clinical antibacterial agents, with allergic reaction as a common adverse reaction; acute immune hemolytic anemia is relatively rare in clinical practice. For elderly patients with liver cirrhosis, a particularly high-risk population, enhanced medication safety monitoring is critical to ensure patient safety.
  • Mechanisms of Kochiae Fructus against Gout: A Study Based on Network Pharmacology and Molecular Docking
    CAI Hua-jing, WU Ling-qun
    2026, 23(6): 589-595. https://doi.org/10.13493/j.issn.1672-7878.2026.06-009
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    Objective: To investigate the therapeutic targets and molecular mechanisms of Kochiae Fructus against gout using network pharmacology and molecular docking, and to provide a theoretical foundation for expanding its clinical applications and developing novel gout treatment strategies. Methods: The active ingredients of Kochiae Fructus were screened and their corresponding targets were predicted using the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), HERB database and Swiss Target Prediction database. Gout targets were retrieved from the GeneCards and OMIM databases and overlapped with the targets of Kochiae Fructus to construct a "drug-active ingredient-target-disease" regulatory network and a protein-protein interaction (PPI) network. Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed. Key active ingredients and core target proteins were screened for molecular docking validation. Results: A total of 8 active ingredients and 130 overlapping targets of Kochiae Fructus were identified. The core targets included IL-6, AKT1, TNF, PPARG and EGFR, which were mainly involved in biological processes such as inflammatory response, PI3K-Akt signaling regulation, and negative regulation of apoptosis. Key enriched pathways included TNF, IL-17, NF-κB, PI3K-Akt and MAPK signaling pathways. Molecular docking results showed that stigmasterol exhibited strong binding affinities to IL-6, AKT1 and PPARG, with low binding energies. Conclusion: Kochiae Fructus may exert synergistic anti-gout effects by regulating inflammatory/immune-related and metabolic pathways.