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  • 2019 Volume 16 Issue 2
    Published: 25 February 2019
      
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  • Progress in Efficacy Evaluation of Drug Synergistic Effects of Matrine for Viral Hepatitis
    ZHANG Ming-fa, SHEN Ya-qin
    2019, 16(2): 185-189. https://doi.org/10.13493/j.issn.1672-7878.2019.02-001
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    Matrine has been used extensively for the treatment of hepatitis B. When matrine combines with interferon, lamivudine, adefovir dipivoxil, entecavir, glycyrrhizic acid-type compounds, reduced glutathione, or thymopeptide, their efficacies are improved. Matrine decreases the occurrences of adverse effects of interferon or diammonium glycyrrhizinate. Matrine promotes recovery rate of TBil of glycyrrhizic acid-type compounds, adefovir dipivoxil and reduced glutathione; it may be relative to accelerating biliation of matrine. The literatures on the synergistic effect of matrine in the treatment of viral hepatitis were reviewed and the evaluation of the synergistic effect was analyzed.
  • Study on Mechanism of Carbapenem Resistance Produced by Imipenem Resistant P.Aeruginosa and Its Molecular Epidemiological Characteristics
    Li Xiaoju, XU Fei, LIU Yang
    2019, 16(2): 190-195. https://doi.org/10.13493/j.issn.1672-7878.2019.02-002
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    Objective: To detect and analyze the mechanism of carbapenem resistance by imipenem resistant P. Aeruginosa (IRPA), and to study its molecular epidemiological characteristics, so as to provide a reference for the prevention and treatment of hospital IRPA infection. Methods: Clinical data from 2016 to 2017 IRPA strains in 80 strains were extracted and strains isolated (producting/non producing IRPA strains, 32 strains and 48 strains, respectively); analyzing of modified carbon black alkene inactivated test method (mCIM) and the method of modified Hodge and polymerase chain reaction (PCR) method to detect the carbapenem enzyme gene; its sequencing showed that positive was to produce/non carbon penicillium enzyme drug-resistant spectrum difference of IRPA strains, as well as analyzing different types of carbon penicillium enzyme resistant and epidemiological characteristics of the strain. Results: Of the 80 IRPA strains isolated, 32 (40.00%) were mCIM phenotype positive, and 15 (18.75%) were modified Hodge positive; the PCR results showed that 13 (16.25%) were VIM-2 gene positive, 19 (23.75%) were kpc-2 gene positive, and both NDM and oxa-48 genes were negative. The drug resistance rates of IRPA strains producing carbapenem to ceftazidime, cefepime, piperacilin-tazobactam, cefoperazone, sulbactam and amikacin were 87.50%, 87.50%, 68.75%, 68.75%, and 68.75%, respectively, which were significantly higher than those of non-carbapene-producing IRPA strains (37.50%, 35.42%, 22.92%, 22.92%, and 35.42%, respectively)(P<0.05). The results of MLST and PFGE typing showed that IRPA strains had 11 genotypes, mainly ST235/A, ST244/D and ST639/K, among which the enzyme-producing IRPA strains were mainly prevalent in ST235/A, ST235/G, ST244/D, ST639/K and ST1029/G. Conclusions: IRPA strains isolated in this region mainly produce VIM-2 and KPC-2 MBL, which were highly resistant to a variety of commonly used clinical antimicrobial agents. The detection and monitoring of enzyme-producing strains should be strengthened to prevent the spreading and prevalence of antimicrobial resistance of these strains.
  • Study on Application of JPKD Population Pharmacokinetics Software in Individualized Administration of Vancomycin*1
    LI Fan, LIU Xiaoling
    2019, 16(2): 195-199. https://doi.org/10.13493/j.issn.1672-7878.2019.02-003
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    Objective: To evaluate the clinical application of vancomycin calculator and JPKD-vancomycin (vancomycin population pharmacokinetics software JPKD) in the individualized administration of vancomycin in hospital infected patients. Methods: Data of hospitalized patients who were clinically admitted to the hospital and consulted by pharmacists for vancomycin were collected from December 2016 to May 2017. Ruling out the severe renal insufficiency (creatinine clearance is less than 30 mL/min), based on the patient's general information (height, body mass, age, serum albumin level and presence of edema and liquid recovery), set and enter the patient's individual parameters, calculate the vancomycin in patients with initial drug dosage; the application of vancomycin agent after 30 min before 5 agent, in 4 patients with blood samples was collected vancomycin blood drug concentration. As the blood drug concentration falls below, using JPKD software (using the bayesian dose feedback method) to enter the patient's first vancomycin to drug dosage, and its related individual information to estimate the pharmacokinetic parameters of individual patients and second input vancomycin forecast to drug dosage, dosing interval and infusion time every time, after being changed by the software on the basis of the above parameters to estimate the dose concentration of vancomycin in the valley, and verified through clinical cases of actual measurement results. Results: All the estimated trough concentrations (12.8±5.9) g/mL were adjusted by JPKD, after which the clinical symptoms were significantly improved. Conclusion: Using JPKD to adjust the blood vancomycin concentration can guide the rational use of vancomycin in clinical practice, and it is helpful for the rational use of vancomycin in clinical practice.
  • Monitoring and Analysis on Blood Concentrations of Vancomycin in Patients with Anti-infective Therapy*1
    NI Chun-yan, QIAN Chun-yan, XIA Zong-ling, HU Nan
    2019, 16(2): 200-204. https://doi.org/10.13493/j.issn.1672-7878.2019.02-004
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    Obiective: To analyze the monitoring results of Vancomycin blood concentration and its clinical medication. Methods: The valley concentration of vancomycin was monitored by homogeneous enzyme amplification immunoassay. The blood drug concentration monitoring results of 106 patients treated with vancomycin in the hospital in the past year, as well as the distribution of pathogenic bacteria and their drug resistance were analyzed. Results: A total of 106 patients were tested for vancomycin anti-infective therapy involving 16 departments. The detection rate of etiology was 91.51%. Vancomycin was sensitive to most gram-positive bacteria, and one strain of enterococcus faecalis was reported to be resistant to vancomycin. The vancomycin concentration was between the range of 10 and 20 g/mL for the first time in 54 patients, the vancomycin concentration was within the range of 10~20 g/mL for the second time in 22 patients with severe infection, and the valley concentration was between the range of 10 and 20 g/mL for 17 patients. Compared with that of the first time, the results of the second blood drug concentration monitoring were significantly improved (P<0.05). Among them, 27 patients failed to receive vancomycin anti-infection treatment, and 7 patients developed vancomycin-related adverse drug reactions, which were improved after withdrawal. Conclusion: The monitoring of vancomycin blood concentration is of great significance for clinical safety and rational drug use. However, the individual differences of vancomycin are large and there are many influencing factors, so clinicians and pharmacists still need to pay more attention to vancomycin.
  • Analysis on Distribution of Mycoplasma of 1 745 Patients with Urogenital Tract Infection and Its Resistance to Common antibiotics
    GUO Xiao-fang
    2019, 16(2): 204-206. https://doi.org/10.13493/j.issn.1672-7878.2019.02-005
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    Objective: To analyze the distribution Mycoplasma of urogenital infection and its resistance to common antimicrobial agents. Methods: Data of 1 745 patients with urogenital tract infection from February 2016 to May 2018 were extracted. The infection status of Mycoplasma was detected with Mycoplasma kit and the results of drug susceptibility test for common antimicrobial agents were analyzed. Results: Among the 1 745 patients with urogenital tract infection, 484 patients were tested to be positive for mycoplasma infection, with a total infection rate of 27.74%. Among them, the infection rate of ureaplasma urealyticum (UU) was 17.19%, the infection rate of Mycoplasma hominis (Mh) was 3.84%, and the infection rate of UU+Mh was 6.70%. The resistance of Mycoplasma to roxithromycin, erythromycin, azithromycin and levofloxacin was higher; joshamycin, minocycline, thiamphenicol, clarithromycin and doxycycline to its sensitivity were higher. Conclusion: The infection rate of ureaplasma urealyticum (UU) in genitourinary tract infection is higher than that of Mycoplasma humanis (Mh). The sensitivity of josamycin, minocycline, thiamphenicol, clarithromycin and doxycycline was higher. It is suggested that the patients with urogenital tract Mycoplasma infection should be treated with josamycin, minocycline, thiamphenicol, clarithromycin and doxycycline first.
  • Analysis on Culture Results of Mycoplasma in Female Patients with Urogenital Tract Infection and Their Resistance to Antimicrobial Agents
    CHEN Shu-ying
    2019, 16(2): 207-209. https://doi.org/10.13493/j.issn.1672-7878.2019.02-006
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    Objective: To analyze the culture results of Mycoplasma in female patients with urogenital tract infection and their resistance to antimicrobial agents. Methods: Clinical data of 227 patients with urogenital tract infection who were admitted to hospital from January 2018 to December 2018 were collected to analyze the results of Mycoplasma culture of cervical secretions and their resistance to antimicrobial agents. Results: Of the 227 female patients with urogenital tract infection, 127 (55.95%) were positive for Mycoplasma secreta from the cervix, among which 99 (77.95%) were Mycoplasma Urealyticum infection, 7 (5.51%) were Human Mycoplasma infection, and 21 (16.54%) were mixed infection. The drug resistance rate of Ureaplasma Urealyticum to cisfomycin, doxycycline and metformin was 0.00%, 1.01% and 2.02%, respectively. The drug resistance rates of ciprofloxacin and erythromycin were 75.76% and 32.32% respectively. The drug resistance rate of Mycoplasma Hominis to josamycin, doxycycline and minocycline was 0.00%, and the drug resistance rate to roxithromycin, clarithromycin and erythromycin was 100.00%. Conclusion: In the clinical use of antibiotics to treat Mycoplasma infection, josamycin, doxycycline and minocycline can be selected to ensure the safety and effectiveness of the patients.
  • Analysis on Related Factors of Antibacterial Medication in 10 800 Prescriptions of Pediatric Out-patients in A Hospital
    LIN Kang-shui, ZENG Chun-tao
    2019, 16(2): 210-213. https://doi.org/10.13493/j.issn.1672-7878.2019.02-007
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    Objective: To analyze the use status of antibacterial drugs in pediatric out-patient department of a hospital and to provide a reference for rational use of antimicrobial agents. Methods: A total of 10 800 prescriptions of pediatric outpatient were selected in 2017, and the number and types of antibacterial drugs used, routes of administration, combined drug use, unreasonable drug prescriptions and other related factors were counted statistically and analyzed. Results: Of the 10 800 prescriptions in 6 825 prescriptions were used antibacterial drugs (63.19%), and the drugs were mainly cephalosporins. The TOP 3 most frequently used antibiotics were cefxime granules (20.50%), cefazolin sodium for injection (16.94%), and cefotaxime sodium for injection (6.45%). Oral administration accounted for 54.46%, injection for 39.43%, and external use for 6.11%. There were 4 644 prescriptions for single drug accounting for 68.04%, and 2 181 prescriptions for double drug accounting for 31.96%. The number of prescriptions for unreasonable use of antibacterial drugs reached 258 accounting for 3.78%. Conclusions: There were some unreasonable uses of antibiotics in the pediatric outpatient of our hospital, which intervention and supervision should be strengthened to ensure the safety and effectiveness of patients' medication.
  • Analysis on Rationality of Antimicrobial Medication of Out-patient Prescriptions in a Community Health Service Center of Shanghai in 2017
    YANG Qi
    2019, 16(2): 213-216. https://doi.org/10.13493/j.issn.1672-7878.2019.02-008
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    Objective: To analyze the rationality of the usage of antibacterial agents in a health service center and to provide a reference for the rational use of antimicrobial agents for primary medical institutions. Methods: A total of 364 359 prescriptions of outpatient from January to December 2017 were selected to analyze the rationality of the types and varieties of antimicrobial drugs used in the prescriptions, as well as their sales amount, medication frequency (DDDs) and daily cost (DDC). Results: Among the 364 359 prescriptions, 20 871 prescriptions for antimicrobial agents accounted for 5.73% of the total prescriptions. The second generation of cephalosporins, macrolides and quinolones were the main antimicrobial agents used. Cefaclor, levofloxacin and cefopropene were the TOP 3 drugs in terms of sales amount. The TOP 3 DDDs drugs were levofloxacin, cefaclor and azithromycin in oral dosage forms. The lowest daily cost (DDC) was the oral dosage form of cefuroxime ester. Conclusion: The usage of antimicrobial agents in the outpatients of the health service center is basically reasonable, but it still needs to be standardized in management to ensure the effectiveness and safety of patient medication.
  • Application of QCC Activities in Reducing Incidence of Unreasonable Medical Advice of PIVAS and Its Intervention Countermeasures
    JIANG Peng-fei, WANG Cai-qin
    2019, 16(2): 217-219. https://doi.org/10.13493/j.issn.1672-7878.2019.02-009
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    Objective: To analyze the reasons for reducing the incidence of doctors' orders for irrational use of PIVAS by carrying out quality control circle(QCC) activities, and to provide a reference for rational use of PIVAS. Methods: Unreasonable medical orders were selected from January to May 2013 (before the activity) and June to December 2013 (after the activity). According to the QCC rules, the unreasonable medication orders of PIVAS were analyzed. The relevant data of unreasonable medication orders before and after the activity were compared. The countermeasures and their implementation were discussed and formulated; the results were evaluated and the continuous improvement was made. Results: The main types of PIVAS unreasonable medication orders were inappropriate solvent selection, improper usage and dosage, incompatibility, etc. After the development of 6 countermeasures to implement the improvement, the number of cases of unreasonable medication orders decreased from 9.60 cases per week to 7.04 cases (P<0.05). Conclusion: It could effectively reduce the incidence of unreasonable medication orders for PIVAS using QCC activities; the safety of medication for patients was promoted.
  • Analysis on Cause and Distribution Tendency of Complications of 9 528 Patients with Pulmonary TB in Suzhou Area from 2011 to 2017*1
    YAO Lin, GU Bin-bin, WANG Xia-fang, SHEN Xing-hua, ZHANG Jian-ping, BAO Zi-wei, SHI Cui-lin, SHEN ying-jie, TANG Pei-jun, WU Mei-ying
    2019, 16(2): 258-261. https://doi.org/10.13493/j.issn.1672-7878.2019.02-025
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    Objective: To analyze the causes and distribution tendency of pulmonary tuberculosis(PTB) complications in Suzhou area, and to provide a reference for improving the diagnosis and treatment of tuberculosis. Methods: The medical records of 9 528 cases of tuberculosis patients were collected from 2011 to 2017, and 6 927 cases of complications were recorded. Patients with extrapulmonary tuberculosis and hemoptysis were included in the adolescent group (n=4 389), and the patients with diabetes, drug resistance and drug response were included in the elderly group (n=2 538). The spectrum, time and age distribution of PTB complications were analyzed. Results: 6 927 hospitalized patients with PTB complications accounted for 72.70% of PTB patients. There were tuberculosis complications such as 3 453 acses of extrapulmonary tuberculosis, 1 075 cases of diabetes, 936 cases of hemoptysis, 389 cases of drug resistance and 1 074 cases of drug reactions. The number of complications in the adolescent group (3 380 cases) was lower than that in the elderly group (3 547 cases) (P<0.05). Extrapulmonary tuberculosis patients (PTB) accounted for 36.24%, diabetes 11.28%, adverse drug reactions 11.27%, hemoptysis 9.82% and drug resistance 4.08%. The incidence of complications is on the rise (χ2=23.503, P<0.01). Conclusion: The main complications of PTB in Suzhou area are extrapulmonary tuberculosis and diabetes mellitus. The patients under 40 years old had the highest probability of extrapulmonary tuberculosis; the drug resistance was easy to occur in patients over 60 years old, so the diagnosis and treatment of complicated PTB should be standardized in order to improve the level of diagnosis and treatment of complicated PTB.
  • Analysis on Related Factors of Adverse Drug Reactions Induced by Olanzapine in 42 Patients
    SHI Wei-hua
    2019, 16(2): 272-275. https://doi.org/10.13493/j.issn.1672-7878.2019.02-030
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    Objective: To observe the characteristics and regularity of adverse drug reactions (ADR) caused by olanzapine in primary psychiatric hospitals, and to provide a reference for clinical rational drug use. Methods: From January 2016 to June 2018, 42 cases of ADRs caused by olanzapine were selected to report to the National Adverse Drug Reaction Monitoring Center, and the characteristics and rules of olanzapine-induced ADRs were analyzed. Results: Among the 42 patients with ADRs, 24 of them had neurological damage accounting for 57.16%. Secondly, 5 cases of metabolic endocrine system accounted for 11.90%. The clinical manifestations were edema, metabolic disorder and increased body mass.The most cases of ADRs occurred by olanzapine at 20 mg/d . After the adverse reactions by olanzapine, 41 cases (97.62%) improved or recovered after treatment. Conclusion: Olanzapine has good safety compared with classical antipsychotic drugs, but enough attention should be paid to the ADRs induced by olanzapine during clinical use and monitoring should be strengthened.
  • Evaluation on Clinical Efficacy and Safety of Tanreqing Combined with Antibiotics in Patients with Pulmonary Infection
    YUAN Gu-Zhi
    2019, 16(2): 286-288. https://doi.org/10.13493/j.issn.1672-7878.2019.02-035
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    Objective: To evaluate the clinical efficacy and safety of Tanreqing combined with antibiotics in patients with pulmonary infection. Methods: 100 patients with pulmonary infection admitted from February 2016 to February 2018 were selected and they were divided into routine group and combined group according to different treatment methods (50 cases in each group). Patients in routine group were given antimicrobial drugs,and patients in combined group were given Tanreqing on the basis of routine group. The total effective rate, recovery time of symptoms and signs (such as body temperature, cough and lung rale), and incidence of adverse reactions during treatment were compared between the two groups. Results: The total effective rate of the combined group was 94.00% higher than that of conventional group(78.00%) (P<0.05). The improvement time of body temperature, cough and lung rale was earlier than that of conventional group (P<0.05). The incidence of adverse reactions was 4.00% lower than that of the conventional group (12.00%) (P<0.05). Conclusion: Tanreqing combined with antibiotics is effective in the treatment of pulmonary infection patients; besides it could effectively promote the recovery of their symptoms and signs, and it is of more safety.