KANGGANRAN YAOXUE

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  • 2023 Volume 20 Issue 3
    Published: 25 March 2023
      
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  • Research Progress in Antiviral Pharmacological Effects of Berberine
    ZHANG Ming-fa, SHEN Ya-qin
    2023, 20(3): 223-227. https://doi.org/10.13493/j.issn.1672-7878.2023.03-001
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    Berberine is an isoquinoline alkaloid found in Chinese herbs Coptidis Rhizome and Phellodendron amurense. With pharmacological effects such as anti-pathogenic microorganisms, anti-inflammation, anti-tumor, lowering blood glucose, regulating blood lipid and immunosuppression, it has been used in the clinical treatment of cardiovascular diseases, digestive diseases, metabolic diseases, tumors, etc. This article summarizes the pharmacological effects of berberine on viruses such as influenza virus, herpes virus, Coxsackie virus B3, trachoma virus, porcine rotavirus, hepatitis B virus and human immunodeficiency virus, and their related mechanisms, providing reference for the clinical application and promotion of berberine.
  • Quality Analysis and Evaluation of Omeprazole Enteric-coated Capsules from Different Manufacturers
    GAO Qiang
    2023, 20(3): 228-231. https://doi.org/10.13493/j.issn.1672-7878.2023.03-002
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    Objective: To analyze and evaluate the drug quality of omeprazole enteric-coated capsules (OEC) from different manufacturers, so as to provide reference for the quality control of drugs. Methods: 13 batches of OECs from different manufacturers were selected as the research objects, and the quality indexes of OECs such as dissolution, impurity content and drug content were inspected and analyzed with the methods contained in Chinese Pharmacopoeia (2020). Results: The dissolution quantity of 13 batches of OECs was higher than 90.00%, which met the relevant requirements of Chinese Pharmacopoeia and reached the standard without testing acid resistance; the content of the largest single impurity and total impurities of 13 batches of OECs was far less than the specified limit. The results of 4 batches of OECs that passed the consistency evaluation were better than those of other batches; the content uniformity of 13 batches of OECs met the requirements, but the results of 1 batch of OECs was 14.24%, which was close to the specified limit of 15.00%, with a great risk; the content of 13 batches of OECs met the standards, but the results of 3 batches of OECs were 91.14%, 92.70% and 93.30%, respectively, which were close to the lower limit of 90.00%, with a great risk. Conclusion: All OECs in different batches from different manufacturers meet the standards, but the results of few batches of OECs are slightly better than the standard limit with a certain product quality risk. Therefore, some manufacturers should continue to improve the drug production quality assurance system to ensure the medication safety.
  • Analysis of Anti-infective Treatment Consultation of 38 Children with Complicated Urinary Tract Infection Involved by Clinical Pharmacists*1
    LI Gui-feng, ZHOU Mi
    2023, 20(3): 232-238. https://doi.org/10.13493/j.issn.1672-7878.2023.03-003
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    Objective: To analyze the relevant characteristics of anti-infective treatment consultation of children with complicated urinary tract infection (cUTI) involved by clinical pharmacists, so as to provide reference for clinical pharmacists to carry out pharmaceutical consultation practices. Methods: A total of 38 children with cUTI who were admitted to Department of Urinary Surgery, Children's Hospital of Soochow University from January 2022 to August 2022 and consulted by clinical pharmacists were selected as the research objects. The children's information were collected, such as age, gender, diagnosis, clinical manifestations, microbiological test results and final outcomes, as well as consultation opinions of clinical pharmacists and their adoption, and the relevant characteristics of anti-infective treatment consultation in children were analyzed. Results: In addition to cUTI, 38 children were complicated with vesicoureteral reflux (21 cases, 55.26%), hydronephrosis (8 cases, 21.05%) and other diseases; the clinical manifestations of 38 children with cUTI were mainly fever (20 cases, 52.63%), elevated white blood cell (WBC) count in urine (38 cases, 100.00%) and positive leukocyte esterase (38 cases, 100.00%), elevated WBC count in blood (23 cases, 60.53%) and elevated C-reactive protein (27 cases, 71.05%). In terms of microbiological test, a total of 42 strains of pathogenic bacteria were detected in 38 children with cUTI, mainly including Pseudomonas aeruginosa (14 cases, 33.33%), Escherichia coli (8 cases, 19.05%) and Klebsiella pneumoniae (7 cases, 16.67%). The drug susceptibility test results showed that the sensitivity rates of three pathogenic bacteria to piperacillin-tazobactam sodium, meropenem, imipenem-cilastatin sodium and amikacin were all high (above 85.00%). For 38 children with cUTI, clinical pharmacists gave a total of 53 consultation opinions, 44 opinions of which were adopted (83.02%), involving 31 children; the outcomes of 30 children (96.77%) were effective, while 5 of the remaining 7 cases (71.43%) had an effective outcome. Among 38 children with cUTI, 10 case had adverse drug reactions during the use of antibacterials, 8 cases of which were related to cefoperazone-sulbactam sodium, with symptoms of diarrhea and rash. Conclusion: The pathogenic bacteria of cUTI in children are mainly Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. When clinical pharmacists participate in the anti-infective treatment consultation, they can provide professional pharmaceutical opinions for the medical team to formulate anti-infection therapeutic regimens, to guarantee the safety and effectiveness of medications for children.
  • Analysis of Pharmaceutical Care of One Patient of Legionella Infection with Mental Disorder and Impairment of Liver and Kidney Functions*1
    YE Qiu-ming, WU Hui-fei, WANG Zhi-en, TIAN Li-feng
    2023, 20(3): 238-241. https://doi.org/10.13493/j.issn.1672-7878.2023.03-004
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    Objective: To analyze the process of anti-infective treatment and pharmaceutical care in one patient of Legionella infection (LI) with mental disorder and impairment of liver and kidney functions, so as to provide reference for the treatment and pharmaceutical care of LI patients. Methods: The clinical pharmacist met a patient with fever pending examination and impairment of liver and kidney functions during the pharmaceutical consultation. During the treatment, the patient developed mental disorder, and the pathogen antibody IgM test indicated that Legionella pneumophila was positive. Results: After consultation, the clinical pharmacist believed that the patient's fever, impairment of liver and kidney functions and mental disorder were possibly related to LI, so he/she suggested giving moxifloxacin anti-infective treatment, supplemented with other symptomatic treatments; soon, the patient's fever and mental disorder symptoms basically disappeared, and the liver function basically returned to normal on the 16th day of admission, so the patient was discharged from the hospital. Conclusion: Clinical pharmacists carry out the consultation and pharmaceutical care, and assist doctors in formulating individualized and more targeted therapeutic regimens for patients to guarantee the treatment safety and efficacy.
  • Case Analysis of Thrombocytopenia in Patients Caused by Linezolid Combined with Cefoperazone-Sulbactam Sodium*1
    MOU Jing-li, LI Qian, MOU Jing-xiu
    2023, 20(3): 242-247. https://doi.org/10.13493/j.issn.1672-7878.2023.03-005
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    Objective: To analyze the correlation between the anti-infective therapy with linezolid combined with cefoperazone-sulbactam sodium and the occurrence of thrombocytopenia in patients and its related preparations, so as to provide reference for the clinical safety of linezolid and cefoperazone-sulbactam sodium. Methods: The patient was admitted to ICU of the hospital because of "sudden chest tightness, shortness of breath and dyspnea for more than 3 hours". It was diagnosed that the patient had pulmonary infection, and Gram-negative and Gram-positive bacteria were found on the subsequent sputum smear, then the patient received anti-infective therapy with cefoperazone-sulbactam sodium and linezolid. Results: After taking cefoperazone-sulbactam sodium and linezolid, the patient had a progressive decrease in platelet count, with a minimum of 78 ×109/L. Considering that both cefoperazone-sulbactam sodium and linezolid could cause thrombocytopenia and the time of medication was strongly correlated with the occurrence of adverse reaction in this case, cefoperazone-sulbactam sodium and linezolid were discontinued immediately, and meropenem and vancomycin were used for treatment. Soon, the patient's platelet index returned to normal. Conclusion: Thrombocytopenia is a common adverse drug reaction of cefoperazone-sulbactam sodium and linezolid. Clinical pharmacists should pay special attention to this situation during the pharmaceutical care, and focus on monitoring the occurrence of adverse drug reactions to ensure the medication safety of patients.
  • Clinical Analysis of One Patient with Acute Pancreatitis Induced by Tigecycline
    ZHANG Jie-qing, YE Xiao-fen, LYU Qian-zhou, LI Xiao-yu, JI Hai-ying
    2023, 20(3): 247-249. https://doi.org/10.13493/j.issn.1672-7878.2023.03-006
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    Objective: To analyze the clinical characteristics and related causes of acute pancreatitis in one patient during the treatment with tigecycline, so as to provide reference for the safety use of tigecycline. Methods: One patient with interstitial pneumonia complicated with infection had epigastric tenderness and amylase abnormalities during the anti-infective treatment with tigecycline and meropenem, and the B-ultrasound showed gallbladder cholestasis and unclear pancreas; so the doctors from Department of Gastroenterology were asked for consultation, and the patient was considered to have acute pancreatitis. Results: Based on the patient's past medical history and current medications, the clinical pharmacist considered that the patient's acute pancreatitis might be caused by tigecycline, and suggested that the doctors stopped the treatment with tigecycline and carried out the symptomatic treatment; on the second day after drug withdrawal, the patient's epigastric tenderness was alleviated, and the amylase level also decreased remarkably. Conclusion: When clinical pharmacists carry out pharmaceutical practices, they should comprehensively consider the patient's past medical history and medications in case of any sudden illness, strengthen the analysis and monitoring of suspicious drugs, actively assist doctors in identifying the possible causes of disease, and guarantee the patient's medication safety.
  • Analysis of Clinical Characteristics and Treatment Outcomes of Patients with Chlamydia Psittaci Pneumoniae in a Hospital
    YU Bing-hui, XU Xiao-ting, QIU Yong-jun, MENG Qing-wei
    2023, 20(3): 254-259. https://doi.org/10.13493/j.issn.1672-7878.2023.03-008
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    Objective: To analyze the clinical manifestations, laboratory indexes and treatment outcomes of patients with Chlamydia Psittaci pneumoniae (CPP), so as to provide reference for improvement of cognition, diagnosis and treatment ability of this disease. Methods: The clinical manifestations, laboratory tests and chest CT results, diagnosis and treatment process, medication for treatment and prognosis of 6 patients with CPP admitted to the hospital from May 2020 to March 2022 were analyzed by metagenomics next-generation sequencing (mNGS). Results: The main clinical manifestation of 6 patients with CPP included was cough, other accompanying symptoms included dizziness, chest tightness, shortness of breath, wheezing and headache, etc. Among them, 4 patients had a definite history of poultry exposure. The laboratory tests of 6 patients with CPP showed that their percentage of neutrophile granulocytes, C-reactive protein, procalcitonin, and liver enzymes increased to varying degrees, of which, 4 patients had hyponatremia, 5 patients had hypokalemia, and 2 patients had elevated total white blood cell count. The chest CT showed consolidation of a lung lobe; the nucleic acid sequence of Chlamydia psittaci was detected by mNGS in respiratory alveolar lavage fluid specimens, in combination with the clinical manifestations and history of poultry exposure, the patient was diagnosed with CPP; after timely initiation of anti-infective treatment, the patient's condition was improved and he/she was discharged from the hospital. Conclusion: The clinical manifestations of patients with CPP have certain specificity and are difficult for diagnosis. The etiological diagnosis can be confirmed by mNGS in time, and the curative effect after drug treatment with doxycycline, azithromycin and levofloxacin is relatively definite.
  • Analysis of Use of Intravenous Glucocorticoids in Emergency Department of a Hospital
    KONG Wei, LU Qiu-hong, SHENG Yu-qing, WANG Yan
    2023, 20(3): 259-262. https://doi.org/10.13493/j.issn.1672-7878.2023.03-009
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    Objective: To analyze the use of intravenous glucocorticoids (GCs) in Emergency Department of a hospital and its rules, so as to provide reference for the standardized management and rational application of such drugs. Methods: All medical records and prescriptions of intravenous glucocorticoids in Emergency Department of Zhenjiang First People's Hospital in 2022 were selected, and a retrospective analysis was performed on the patients' general conditions, prescription drugs, indications, usage and dosage, combined medications, etc. Results: Among 3 855 prescriptions, the most used intravenous GCs drug was dexamethasone (97.74%); the disease types for patients mainly included 1 122 cases of inflammatory diseases (29.11%), 1 079 cases of respiratory diseases (27.99%), 848 cases of infectious diseases (22.00%) and 384 cases of allergy-related emergencies (9.96%). The main routes of administration included intravenous injection for 3 574 cases (92.71%) and intravenous drip for 281 cases (7.29%). The combined use of intravenous GCs in emergency patients mainly included combined use of antibacterials for 1 709 cases (41.10%) and combined use of aminophylline injection for 1 234 cases (29.68%). Conclusion: There are still some irrational drug use phenomena in the process of intravenous administration of GCs drugs in Emergency Department of the hospital, and it is necessary to further strengthen drug management and special comments.
  • Analysis of Comments on Medication of Xuebijing Injection Based on Evidences
    GU Xiao-ying, YAN Jie
    2023, 20(3): 263-266. https://doi.org/10.13493/j.issn.1672-7878.2023.03-010
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    Objective: To explore the main points for comments on medication of Xuebijing injection based on evidence-based evidences, so as to provide reference for the safe and rational use of such drug in clinical practices. Methods: The main points for comments on medication of Xuebijing injection were formulated in accordance with Guiding Principles for Clinical Application of Chinese Patent Medicines, Basic Principles of Clinical Use of Traditional Chinese Medicine injections, relevant guidelines, expert consensus and other literatures, and in combination with the package insert of Xuebijing injection. Results: Based on evidence-based evidences, the main points for comments on medication of Xuebijing injection included function and indication, usage and dosage, combined medication, other precautions, etc. to standardize the details such as indications, route of administration, solvent selection, dosage, dispensing concentration, course of medication, drug interactions and medication contraindications of Xuebijing injection. Conclusion: The comments on rational medication of traditional Chinese medicine injections have always been a clinical focus and difficulty. Standardizing the use of traditional Chinese medicine injections is not only related to the safety and health of patients, but also conducive to the development of traditional Chinese medicine industry.
  • Systematic Evaluation of Rabeprazole and Esomeprazole in Treatment of Helicobacter Pylori Positive Peptic Ulcer*1
    LIU Wen-xia, ZHU Ying, WANG Wei, XU Ya, LI Guo-dong
    2023, 20(3): 270-276. https://doi.org/10.13493/j.issn.1672-7878.2023.03-012
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    Objective: To analyze rabeprazole and esomeprazole in the treatment of Helicobacter pylori (Hp) positive peptic ulcer, and evaluate their radical rate and safety. Methods: All relevant literatures about rabeprazole and esomeprazole in the treatment of Hp positive peptic ulcer were searched in databases such as PubMed, Cochrane Library, Foreign Medical Literature Retrieval Service, CNKI, Wanfang Database, VIP database and Chinese biomedical literature database using a computer (with rabeprazole as intervening measure in the study group and esomeprazole in the control group). The literatures were screened according to the inclusion and exclusion criteria. After literature quality assessment and characteristic description, RevMan 5.2 statistical software was used for Meta analysis of literature statistics data. Results: Twenty articles were included, with a total of 3 473 patients. Meta analysis results showed that the eradication rate of esomeprazole for Hp positive peptic ulcer was significantly higher than that of rabeprazole (RR=0.90, 95% CI: 0.88-0.93, Z=6.19, P<0.001); rabeprazole and esomeprazole had basically the same eradication rate for Hp in fast metabolizing CYP2C19 patients (OR=0.70, 95% CI: 0.48-1.03, Z=1.83, P>0.05); rabeprazole was more effective for patients with slow metabolism (OR=2.39, 95% CI: 0.29-0.88, Z=2.39, P<0.05); both had the same adverse drug reaction, mainly headache and thirst (OR=1.05, 95% CI: 0.74-1.50, Z=0.28, P>0.05). The funnel plots of rabeprazole and esomeprazole in the treatment of Hp positive peptic ulcer were basically symmetrical, suggesting no obvious publication bias. Conclusion: The therapeutic regimen based on esomeprazole has obvious advantages in Hp eradication, while rabeprazole has more advantages in terms of economy, so it is suggested that the therapeutic regimen should be chosen by weighing their advantages and disadvantages according to the patient's own situation. For Hp treatment of patients with CYP2C19 genotype, rabeprazole treatment is better for patients with slow metabolism. However, due to the poor methodological quality of the included literatures and a lack of more detailed disease course and genotype, more large-scale and multi-center studies are needed for a secondary systematic analysis.
  • Influencing Factors of Disease Outcome in Patients with Extensively Drug-resistant Acinetobacter Baumannii Pulmonary Infection and Construction of Prediction Model
    ZHENG Yuan-qing, LI Xue, ZHANG Qian
    2023, 20(3): 277-281. https://doi.org/10.13493/j.issn.1672-7878.2023.03-013
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    Objective: To analyze the influencing factors of disease outcome in patients with extensively drug-resistant Acinetobacter baumannii (XDR-AB) pulmonary infection, and construct a Logistic regression prediction model, so as to provide reference for early prediction and development of prevention measures in clinical practices. Methods: A total of 120 patients with XDR-AB pulmonary infection admitted to the hospital from February 2017 to December 2020 were selected as the research objects. Information of patients such as gender, age, diagnosis, complication, length of stay, medication, examination index, and outcome were collected, the influencing factors of disease outcome were analyzed and a Logistic regression prediction model was constructed. Results: Among 120 patients with XDR-AB pulmonary infection, 68 survived (56.67%) and 52 died (43.33%) after treatment. Univariate analysis showed that the rate of admission to ICU, rate of combined cardiac insufficiency, rate of combined respiratory failure, rate of combined use of antifungal drugs, rate of use of antibacterial drugs for less than 6 days, rate of use of noninvasive ventilator, rate of invasive ventilation, rate of indwelling gastric tube and rate of the highest body temperature (below 38.6℃) at the time of infection in the survival group were lower than those in the death group (P<0.05). Multivariate analysis showed that XDR-AB pulmonary infection was closely related to cardiac insufficiency, combined use of antifungal drugs and invasive ventilation of patients (P<0.05), all of which were risk factors for XDR-AB infection (P<0.05). The use of antibacterial drugs for less than 6 days was a protective factor (P<0.05). The likelihood ratio (χ2, Wald χ2) test indicated that the model constructed was effective. The test of Hosmer-Lemeshow goodness of fit indicated a good fitting effect of the model. Conclusion: There are many influencing factors of disease outcome in patients with XDR-AB pulmonary infection. Patients with cardiac insufficiency, combined use of antifungal drugs and invasive mechanical ventilation are independent risk factors for XDR-AB infection, while the use of antibacterial drugs for less than 6 days is a protective factor. The Logistic regression prediction model has good predictive value for disease outcome in patients with XDR-AB pulmonary infection.
  • Early Prediction Analysis of Sepsis-associated Acute Kidney Injury Based on Laboratory Index Model*1
    LI Na, LIN Ting-fang, LU Ying, HE Xing-hua, LI Jun, WANG Bo
    2023, 20(3): 281-285. https://doi.org/10.13493/j.issn.1672-7878.2023.03-014
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    Objective: To analyze the early prediction ability of sepsis-associated acute kidney injury (SA-AKI) based on laboratory indexes such as procalcitonin (PCT), renal resistance index (RRI), and L selectin (CD62L), so as to provide reference for early detection, early diagnosis and early treatment of patients suffering from SA-AKI. Methods: A total of 80 sepsis patients admitted to the hospital from August 2020 to May 2022 were selected as the research objects. The patients were divided into the occurrence group (n=30) and the non-occurrence group (n=50) based on whether SA-AKI occurred. General information of patients and levels of CD62L, PCT and RRI were collected, and a model was established to analyze the early prediction ability of combined detection of CD62L, PCT and RRI for SA-AKI. Results: The levels of PCT, CD62L and RRI of patients in the occurrence group were higher than those in the non-occurrence group (P<0.05). The area under the curve (AUC) value (0.992) of SA-AKI predicted by the combined detection of PCT, CD62L and RRI was higher than the AUC value (0.882, 0.943, 0.911) of single prediction. The sensitivity, specificity and Youden index of combined detection were higher than those of single detection. Conclusion: The occurrence of SA-AKI can be predicted more accurately based on indexes such as PCT, CD62L and RRI, and SA-AKI can be foreseen more accurately by combining the three indexes, which is beneficial to successful treatment and cure of patients with SA-AKI.
  • Analysis of Clinical Use of Amlodipine Besylate Tablet, a Hypotensive Drug Selected from Centralized Purchase Based on Real World*1
    SHEN Jian-fei, ZHU Xing-yu, JIN Xiao-qin, WU Yan, MA Wen-xiang
    2023, 20(3): 286-291. https://doi.org/10.13493/j.issn.1672-7878.2023.03-015
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    Objective: To analyze the clinical use, clinical efficacy and safety of amlodipine besylate tablet selected from centralized purchase, and further explore the new mode and new method of pharmaceutical services under the new situation. Methods: A total of 744 hypertensive patients treated with amlodipine besylate tablet in Taicang Traditional Chinese Medicine Hospital from November 2019 to June 2021 were selected as the research objects, and the use, clinical efficacy and medication safety of amlodipine besylate tablet of centralized purchase and non-centralized purchase were analyzed and evaluated. Results: The change rate of drugs selected from centralized purchase for patients was 82.25%, the rate of blood pressure control reaching the standard was 66.83%, and the occurrence rate of adverse drug reaction of drugs selected from centralized purchase was 10.62%. There was no significant difference in the efficacy and safety of drugs selected from centralized purchase and non-selected drugs (P>0.05). Pharmaceutical services have promoted the use of drugs selected from centralized purchase, improved medication compliance, and increased the rate of blood pressure control reaching the standard from 45.92% to 66.83%. Conclusion: Drugs selected from centralized purchase have been recognized by doctors and patients, and pharmaceutical services with pharmacists as the main body can improve drug efficacy and safety in the management of chronic diseases such as hypertension.
  • Analysis of Causes for Retreatment of 97 Patients with Retreated Pulmonary Tuberculosis (Positive in Sputum Examination) in a Hospital and Their Resistance to Anti-tuberculosis Drugs
    LI Xian-rui, CHEN Jie, PENG Jiang-li
    2023, 20(3): 304-307. https://doi.org/10.13493/j.issn.1672-7878.2023.03-019
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    Objective: To investigate the causes for retreatment of patients with retreated pulmonary tuberculosis (positive in sputum examination) in the hospital and their resistance to anti-tuberculosis drugs, and provide reference for the clinical treatment of such patients. Methods: A total of 97 patients with retreated pulmonary tuberculosis (positive in sputum examination) admitted to the Department of Tuberculosis of Kunming Third People's Hospital from January 2019 to December 2021 were selected as the subjects, and the causes for retreatment and the characteristics of drug resistance to common anti-tuberculosis drugs were investigated. Results: Among the 97 patients with retreated pulmonary tuberculosis (positive in sputum examination), their drug resistance rates to isoniazid and rifampicin were the highest (67.01% and 75.26%, respectively), and their drug resistance rates to capreomycin and amikacin were the lowest (12.37% and 11.34% respectively); 78 of the 97 patients with retreated pulmonary tuberculosis (positive in sputum examination) had the drug resistance. The main drug resistance type was multidrug-resistant tuberculosis (44 cases, 56.41%), followed by extensively drug-resistant tuberculosis (18 cases, 23.08%) and monodrug-resistant tuberculosis (13 cases, 16.67%). The main cause for the retreatment of 97 patients with retreated pulmonary tuberculosis (positive in sputum examination) was relapse (63 cases, 64.95%), and the main drug-resistant type was multidrug-resistant tuberculosis (36 cases, 57.14%). Conclusion: The main cause for the retreatment of patients with retreated pulmonary tuberculosis (positive in sputum examination) is relapse, and the main drug-resistant type is multidrug-resistant tuberculosis, indicating that the drug resistance in pulmonary tuberculosis patients is still in a severe situation. Clinically, it is necessary to further strengthen the management of patients, and urge them to receive standardized treatment to reduce the relapse.