KANGGANRAN YAOXUE

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  • 2022 Volume 19 Issue 11
    Published: 25 November 2022
      
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  • Research Progress in Antiviral Therapy for Co-infection of Human Immunodeficiency Virus and Hepatitis B Virus*1
    ZHANG Ying-jie, WANG Chun-fang
    2022, 19(11): 1507-1510. https://doi.org/10.13493/j.issn.1672-7878.2022.11-001
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    Infection of human immunodeficiency virus (HIV) and infection of hepatitis B virus (HBV) are both infectious diseases with strong social harm, in similar transmission routes, so HIV-HBV co-infection is more likely to occur in clinical practice. With the extensive HIV early screening and antiviral treatment, the survival period of people infected with HIV has been greatly prolonged. However, studies have shown that, even if HIV and HBV replication can be effectively inhibited, the incidence rate and mortality of persons co-infected with HIV/HBV are significantly higher than those of persons affected with HIV or HBV alone. In the face of such challenges, the author summarizes antiviral drugs and treatment regimens for HIV or HBV infection, aiming to provide reference for clinical treatment of persons co-infected with HIV/HBV.
  • Quality Analysis of Amoxicillin Oral Preparations from Different Manufacturers in Suzhou
    XU Dan, CHEN Rong
    2022, 19(11): 1511-1515. https://doi.org/10.13493/j.issn.1672-7878.2022.11-002
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    Objective: To investigate the quality status of amoxicillin oral preparations produced and circulated in Suzhou in the past three years, so as to protect the quality and safety of amoxicillin oral preparations. Methods: A total of 43 batches of amoxicillin oral preparations (including 34 batches of capsules, 6 batches of dispersible tablets and 3 batches of granules) from different manufacturers in Suzhou were selected as the study data, and the impurity content, drug content, dissolution and polymer content of amoxicillin oral preparations in different batches were analyzed with reference to the normative data such as the Chinese Pharmacopoeia and national standards. Results: In terms of impurity content, the total impurity content of 23 of 34 batches of capsules was 0.30%-1.90%; the impurity content of the remaining 11 batches of capsules was tested according to the national standard, and the test results met the standard requirements, and the total impurity content of 6 batches of dispersible tablets was 0.18%-0.28%. In terms of drug content, the results of 34 batches of capsules were 91.42%-101.95%, the results of 6 batches of dispersible tablets were 93.30%-97.44%, and the results of 3 batches of granules were 98.93%-101.31%. In terms of dissolution, the determination results of 34 batches of capsules were 85.67%-103.80%, and the determination results of 6 batches of dispersible tablets were 81.33%-100.64%. In terms of polymer content, 33 of 34 batches of capsules underwent separation test with Sephadex G-10 gel column, and the results were 0.01%-0.18%. Another batch was tested by molecular exclusion reverse phase high performance liquid chromatography (RP-HPLC) with TSK-GEL G2000SWXL gel column, and the results were 0.60%. Conclusion: The indicators of the 43 batches of amoxicillin oral preparations such as impurity content, drug content, dissolution and polymer content meet the national standards, and drugs from the same manufacturer fluctuate slightly in the relevant indicators, but drugs from different manufacturers have great differences in the relevant indicators, so it is necessary for the relevant administrative departments to continue to carry out quality inspection on drugs to ensure the drug safety of patients.
  • Analysis of Intervention of Antibacterial Drugs Prescribed by Doctors Participated by Clinical Pharmacists*1
    HUANG Rong-rong, ZHU Yong-hong
    2022, 19(11): 1516-1521. https://doi.org/10.13493/j.issn.1672-7878.2022.11-003
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    Objective: To analyze the intervention of antibacterial drugs prescribed by doctors led by clinical pharmacists, and provide reference for the rational use of clinical antibacterial drugs. Methods: With the hospital information system, 1 226 orders of antibacterial drugs that were intervened by clinical pharmacists from June 2019 to September 2020 were collected, and the irrational reasons and intervention results of the orders of antibacterial drugs involved were analyzed, as well as the distribution of departments, distribution of drug varieties and changes in the use of antibacterial drugs where the orders were successfully intervened. Results: A total of 1 140 of the 1 226 orders of antimicrobial drugs were successfully intervened. The irrational reasons for the orders were mainly the long course of medication (369 orders, accounting for 32.37%), inappropriate drug selection (190 orders, accounting for 16.67%), excessive single dosage (172 orders, accounting for 15.09%), inappropriate combination medication (148 orders, accounting for 12.98%) and excessive frequency of administration (130 orders, accounting for 11.40%). The departments involved in the 1 140 orders of antibacterial drugs successfully intervened were mainly orthopedics (212 orders, accounting for 18.60%), stomatology (152 orders, accounting for 13.33%), hepatobiliary surgery (107 orders, accounting for 9.39%) and hand surgery (103 orders, accounting for 9.04%). The irrational reason of the orders of orthopedics, stomatology and hand surgery was mainly the long course of medication, while the irrational reason of the orders of hepatobiliary surgery was mainly the inappropriate drug selection. The 1 140 orders of antibacterial drugs that were successfully intervened mainly involved cefazolin pentahydrate (252 orders, accounting for 22.11%), cefazoxime (190 orders, accounting for 16.67%) and levofloxacin (118 orders, accounting for 10.35%). The irrational reason of the orders of cefazolin pentahydrate and cefazoxime was mainly the long course of medication, while the irrational reason of the orders of levofloxacin was mainly the high frequency of administration. From June 2019 to September 2020, the sales amount of antibacterial drugs in all clinical departments decreased to varying degrees, with the largest decline in orthopedics and stomatology. In addition, the use frequency of antibacterial drugs in orthopedics, urology and digestive medicine also decreased significantly. Conclusion: The medication intervention of clinical pharmacists is acceptable in clinical practice, which can effectively promote the rational use of clinical antibacterial drugs and ensure the safety and effectiveness of patient medication.
  • Analysis of Distribution and Drug Resistance of Pathogenic Bacteria in Urine Samples of 118 Children with Urinary Tract Infection in a Hospital
    ZHANG Jin-yi, DENG Bin
    2022, 19(11): 1522-1525. https://doi.org/10.13493/j.issn.1672-7878.2022.11-004
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    Objective: To analyze the distribution and drug resistance of pathogenic bacteria in urine samples of children with urinary tract infection in the hospital, and to provide reference for rational drug use of children with clinical urinary tract infection. Methods: A total of 118 children with urinary tract infection admitted to Pingxiang Maternity and Child Care Hospital from January 2021 to December 2021 were selected as the study subjects, and the distribution and drug resistance of pathogenic bacteria in urine samples of children were statistically analyzed. Results: A total of 129 strains of pathogenic bacteria were detected in the urine samples of 118 children with urinary tract infection, including 82 strains of Gram-negative bacteria (accounting for 63.56%, mainly Escherichia coli and Klebsiella pneumoniae), 46 strains of Gram-positive bacteria (accounting for 35.66%, mainly Enterococcus faecalis and Enterococcus faecium) and 1 strain of fungus (accounting for 0.78%). The results of drug sensitivity showed that Escherichia coli had low resistance to amikacin, imipenem, piperacillin and amoxicillin (less than 30.00%), and Klebsiella pneumoniae had low resistance to amikacin, imipenem, piperacillin and ciprofloxacin (less than 30.00%). Enterococcus faecalis had low resistance to vancomycin, linezolid, ampicillin and penicillin (less than 30.00%), and Enterococcus faecalis had resistance only to vancomycin and linezolid (less than 10.00%). Conclusion: The main pathogens of urinary tract infection in children are Escherichia coli, Klebsiella pneumoniae and Enterococcus, which have high resistance to many common antibacterial drugs, and antibacterial drugs should be reasonably selected according to the drug resistance of different pathogenic bacteria during clinical anti-infection treatment, so as to ensure the effect of drug treatment.
  • Analysis of Etiological Characteristics and Risk Factors of Pulmonary Infection in Patients with Liver Cirrhosis
    ZHAO Chun-li, FENG Feng-wei
    2022, 19(11): 1554-1558. https://doi.org/10.13493/j.issn.1672-7878.2022.11-014
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    Objective: To analyze the etiological characteristics and risk factors of pulmonary infection (PI) in patients with liver cirrhosis (HC), and provide reference for the prevention and treatment of PI in HC patients. Methods: A total of 424 patients with HC admitted to the Department of Respiratory Medicine of the hospital from February 2020 to October 2021 were selected as the study subjects, and the incidence of PI as well as the etiological characteristics and risk factors of PI were statistically analyzed. Results: A total of 66 of 424 patients with HC had PI, with the incidence rate of 15.57%. A total of 76 strains were isolated from sputum samples of 66 patients with PI, including 45 strains of Gram-negative bacteria (accounting for 59.21%, mainly Escherichia coli and Klebsiella pneumoniae), 29 strains of Gram-positive bacteria (accounting for 38.16%, mainly Staphylococcus aureus) and 2 strains of fungi (accounting for 2.63%, mainly Candida albicans). The results of drug sensitivity test showed that the drug resistance rate of Escherichia coli to tobramycin, gentamicin, imipenem and amikacin was 0.00%, while the drug resistance rate of Klebsiella pneumoniae to all the tested antibacterial drugs was low (less than 20.00%). The results of regression analysis showed that the complication of PI in patients with HC was related to age, viral hepatitis, invasive procedures, length of hospitalization and Child-Pugh grade of liver function (P<0.05). Age greater than or equal to 60 years, invasive procedures and Grade C of Child-Pugh grade of liver function were independent risk factors for the development of PI (P<0.05). Conclusion: Patients with HC are at risk of PI, the pathogens causing PI are mainly Gram-negative bacteria, and the occurrence of PI is closely related to age, invasive procedures and Child-Pugh grade of liver function. Clinical monitoring and management of patients at high risk of HC should be enhanced to avoid and reduce the occurrence of PI and to ensure the follow-up treatment of HC.
  • Analysis of Risk Factors and Etiological Characteristics of Postoperative Infection in Gastrointestinal Surgery Patients in a Hospital
    ZHOU Li-ren
    2022, 19(11): 1558-1562. https://doi.org/10.13493/j.issn.1672-7878.2022.11-015
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    Objective: To analyze the risk factors and etiological characteristics of postoperative infection in gastrointestinal surgery patients in the hospital, and provide reference for the prevention and treatment of postoperative infection in gastrointestinal surgery patients. Methods: A total of 465 gastrointestinal surgery patients admitted to the People's Hospital of Ruichang for surgical treatment from August 2020 to March 2022 were selected as the study subjects. The patients were divided into infection group (n=81) and non-infection group (n=384) according to the occurrence of the postoperative infection. The types of postoperative infection, related risk factors, distribution of pathogenic bacteria and drug resistance characteristics of patients were statistically analyzed. Results: The main types of infection in 81 patients with postoperative infection were incision infection in 30 cases (accounting for 37.04%), lung infection in 27 cases (accounting for 33.33%) and abdominal infection in 17 cases (accounting for 20.99%). The results of regression analysis showed that postoperative infection in gastrointestinal surgery patients was related to age, body mass index, diabetes, smoking, operation time, operation mode and retention of drainage tube (P<0.05). Among them, age greater than or equal to 60 years, body mass index greater than or equal to 25, diabetes, smoking, operation time longer than or equal to 90min, open surgery and retention of drainage tube were independent risk factors for postoperative infection (P<0.05). A total of 146 strains of pathogenic bacteria were detected from 81 patients with postoperative infection, including 87 strains of Gram-negative bacteria (accounting for 59.59%, mainly Escherichia coli and Pseudomonas aeruginosa), 44 strains of Gram-positive bacteria (accounting for 30.14%, mainly Staphylococcus aureus) and 15 strains of fungi (accounting for 10.27%). The results of drug sensitivity showed that the drug resistance rates of Escherichia coli to cefotetan, cefepime and piperacillin-tazobactam sodium were low (less than 30.00%), and the drug resistance rates of Pseudomonas aeruginosa to cefepime and levofloxacin were low (less than 20.00%). The drug resistance rates of Staphylococcus aureus to ceftazidime, tegacycline and furantoin were low (less than or equal to 10.00%). Conclusion: The postoperative infection of gastrointestinal surgery patients in the hospital is closely related to age, body mass index, diabetes, smoking, operation time, operation mode and retention of drainage tube. Clinical management should be enhanced for high-risk patients to prevent infection. In addition, the pathogenic bacteria of patients complicated with postoperative infection mainly include Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus, and these pathogenic bacteria have strong drug resistance, so that during clinical treatment, antibacterial drugs should be reasonably selected according to the characteristics of the infective pathogenic bacteria to ensure the effect of treatment.
  • Analysis of Adverse Drug Reactions Associated with Antimicrobial Agents in a Hospital from 2019 to 2021*1
    LI Xin-shuai, ZHOU Jia-qi, HOU Rong-gui CHEN Xia
    2022, 19(11): 1569-1574. https://doi.org/10.13493/j.issn.1672-7878.2022.11-018
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    Objective: To analyze the clinical characteristics of adverse drug reactions (ADRs) related to antibacterial drugs reported by the hospital from 2019 to 2021, and provide reference for the safe use of antibacterial drugs in clinical practice. Methods: A total of 194 reports of ADRs related to antibacterial drugs reported by Nantong First People's Hospital to the National Adverse Drug Reaction Monitoring System from January 2019 to December 2021 were selected as the research data, and the distribution of gender and age of patients with ADRs related to antibacterial drugs, the types of antibacterial drugs involved, the time of occurrence, the organs (or systems) involved and their clinical manifestations, and the final outcome were statistically analyzed. Results: A total of 194 cases of ADRs were mainly reported as "mild" (141 cases, accounting for 72.68%) and "serious" (49 cases, accounting for 25.26%). The drugs involved were mainly of a dosage form of injection (187 cases, accounting for 96.39%). The correlation evaluation was mainly "possible" (102 cases, accounting for 52.58%) and "likely" (89 cases, accounting for 45.88%). In 194 ADRs reports, the proportion of female patients was slightly higher than that of male patients (59.79% vs 40.21%), and the proportion of patients younger than 18 years old was higher (89 cases, accounting for 45.88%). The types of antibacterial drugs involved in 194 ADRs reports were mainly macrolides (41 cases, accounting for 21.13%), penicillins (37 cases, accounting for 19.07%), cephalosporins (37 cases, accounting for 19.07%) and quinolones (36 cases, accounting for 18.55%). The main types involved were azithromycin (40 cases, accounting for 20.62%), mezlocillin (34 cases, accounting for 17.53%), moxifloxacin (20 cases, accounting for 10.31%), ceftriaxone and levofloxacin (15 cases, accounting for 7.73%). Most of the 194 cases of ADRs occurred within 1 day after medication (166 cases, accounting for 85.57%), of which the majority occurred within 10-30 minutes after medication (66 cases, accounting for 34.02%). 194 cases of ADRs mainly involved the skin and its adnexa (99 cases, accounting for 51.03%), digestive system (27 cases, accounting for 13.92%), systemic damage (21 cases, accounting for 10.82%) and cardiovascular system (20 cases, accounting for 10.31%) of the patients. After symptomatic treatment, 42 of the 194 patients with ADRs recovered (accounting for 21.64%) and 137 improved (accounting for 70.62%). Conclusion: In hospital clinic, patients have more ADRs during the use of antibacterial drugs, and some of them have serious symptoms. Although most of them can recover or improve after symptomatic treatment, clinical monitoring of adverse reactions of antibacterial drugs should be enhanced, especially for azithromycin, mezlocillin, moxifloxacin, ceftriaxone, levofloxacin and other major varieties to ensure the drug use safety of patients.
  • Pharmaceutical Care of Anti-infection Treatment in a Child with Community-acquired Pneumonia
    LIANG Yao, YU Li-juan, ZHONG Li-cheng, CHEN Feng-ling, ZHONG Chao
    2022, 19(11): 1577-1580. https://doi.org/10.13493/j.issn.1672-7878.2022.11-020
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    Objective: To analyze the anti-infection treatment process of a child with community-acquired pneumonia (CAP), and assist doctors to formulate appropriate anti-infection treatment regimen through pharmaceutical care, so as to provide reference for the safe and effective treatment of children with CAP. Methods and Results: The clinical pharmacist found that the patient had fever for several days and was allergic to penicillin and ceftriaxone during the pharmaceutical care of anti-infection treatment for a CAP patient admitted to the hospital. The infection symptoms did not improve significantly after the treatment with cefixime and clindamycin. Considering the existence of bacterial resistance or incomplete coverage of antibacterial spectrum, and roxithromycin used in out-of-hospital treatment was ineffective, the clinical pharmacist suggested to use levofloxacin or moxifloxacin for treatment after consulting the relevant literatures. Clinicians adopted the suggestion to use moxifloxacin, and clinical pharmacists carried out adverse drug reaction monitoring at the same time. After 2 days, the body temperature of the child returned to normal, and other infection symptoms also improved significantly, with no adverse drug reactions occurred in bone and muscle. Conclusion: With regard to this patient with CAP, the clinical pharmacist actively assisted the doctor to formulate and adjust the anti-infection treatment regimen by taking advantage of his professional expertise, thus effectively guaranteeing the treatment effect and drug use safety of the child.
  • Analysis of Clinical Characteristics of 144 Patients Infected with SARS-Cov-2 Omicron Variant at Different Ages in Suzhou at the Beginning of 2022*1
    SHI Cui-lin, CHENG Jun-ping, ZHANG Jian-ping, SUN Gang, LIU Yi-an, WU Mei-ying, LU Jing, ZENG Ling-wu, LI Xiao-hong, RAN Da-wei, HAO Dong-lin, GAO Jing-dong, CAO Xu, XUE Wen-jing, ZHAI Yun-liang
    2022, 19(11): 1581-1586. https://doi.org/10.13493/j.issn.1672-7878.2022.11-021
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    Objective: To analyze the clinical characteristics of 144 patients infected with SARS-Cov-2 Omicron variant (Omicron for short) at different ages in Suzhou at the beginning of 2022, and provide reference for clinical treatment of Omicron infected patients. Methods: A total of 144 patients with Omicron infection in Suzhou admitted to the Infectious Diseases Hospital affiliated to Soochow University from February 14, 2022 to March 6, 2022 were selected as the study subjects. According to their age, the patients were divided into the juvenile group (less than 18 years old, 22 cases), the young and middle-aged group (18 to less than 60 years old, 95 cases) and the elderly group (greater than or equal to 60 years old, 27 cases). The clinical symptoms, laboratory indexes, symptoms duration, nucleic acid conversion to negative. treatment outcome and other characteristics of the patients at different ages were statistically analyzed. Results: Of the 144 patients with Omicron infection, 84 (accounting for 58.33%) and 32 (accounting for 22.22%) were clinically classified as mild and common types, and 116 (accounting for 80.56%) were vaccinated. Among them, 10, 67 and 39 cases were vaccinated with 1, 2 and 3 vaccines, respectively. There were differences among the three groups in fever, cough, nausea and vomiting, and chest tightness (P<0.05). The incidence rate of fever, cough and chest tightness in the juvenile group was higher than that in the other two groups (P<0.05). There were differences among the three groups in laboratory indexes such as lymphocyte count, glutamic-oxaloacetic transaminase, albumin, total protein, creatinine, D-dimer and myoglobin (P<0.05). With regards to 116 patients with mild and common type Omicron infection, there were differences among the patients at different ages in the duration of symptoms such as pharyngeal discomfort, nasal congestion, nausea and vomiting, anorexia and diarrhea (P<0.05), and the duration of symptoms in the elderly group was longer (P<0.05). There were differences among the three groups in the course of disease, length of stay and days of nucleic acid conversion to negative (P<0.05), and the course of disease, length of stay and days of nucleic acid conversion to negative in the elderly group were greater than those in the other two groups (P<0.05). Conclusion: This round of local Omicron infection in Suzhou is mainly in young and middle-aged patients, mainly with mild and common symptoms, but the course of disease, length of stay and days of nucleic acid conversion to negative in the elderly patients are relatively longer. Therefore, more attention should be paid to the elderly patients in the treatment process.