KANGGANRAN YAOXUE

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  • 2023 Volume 20 Issue 11
    Published: 25 November 2023
      
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  • Research Progress in Pharmacological Effects and Mechanism berberine against Salmonella, Shigella, Vibrio, Mycobacterium and Klebsiella
    ZHANG Ming-fa, SHEN Ya-qin
    2023, 20(11): 1117-1122. https://doi.org/10.13493/j.issn.1672-7878.2023.11-001
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    Berberine has a broad-spectrum antibacterial effect and has good inhibitory effects on Escherichia coli, Helicobacter pylori, cocci, etc. By acting on multiple targets, berberine can interfere with the metabolism of polysaccharides, lipids, amino acids, nucleic acids and proteins in bacteria, thereby disrupting the formation of cell membranes and walls. In addition, berberine can enhance the function of immune cells, improve the defense and killing ability of the body against bacteria. Berberine is not only less susceptible to bacterial resistance, but also can inhibit the occurrence of bacterial resistance to other antibacterial drugs. This article mainly reviews and analyzes the pharmacological effects and mechanism of berberine against Salmonella, Shigella, Vibrio, Mycobacterium, and Klebsiella pneumoniae, providing reference for further clinical research of berberine.
  • Analysis of Typical Cases and Monitoring Points of Patients with Allergic Bronchopulmonary Mycosis*1
    DING Xiao-lan, NI Chun-yan
    2023, 20(11): 1123-1126. https://doi.org/10.13493/j.issn.1672-7878.2023.11-002
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    Objective: To analyze the typical clinical characteristics and pharmaceutical care points of patients with allergic bronchopulmonary mycosis (ABPM), and to provide reference for standardized treatment and medication safety of such patients. Methods: 23 ABPM patients admitted to Respiratory and Critical Care Department of the First People's Hospital of Changzhou from October 2021 to October 2022 were selected as the research subjects. The pathogens, comorbidities, and underlying diseases of the patients were observed, and the pharmaceutical care points of 4 typical cases were analyzed. Results: Among 23 patients, the main pathogen of ABPM was Aspergillus (22 cases, 95.65%), and the underlying diseases of the patients were mainly bronchiectasis (7 cases, 30.44%) and bronchial asthma (5 cases, 21.74%), with comorbidities as allergic rhinitis (8 cases, 34.78%) being more common. The pharmaceutical care analysis of typical cases showed that antifungal drugs such as itraconazole and voriconazole had significant drug interactions with drugs such as atorvastatin and omeprazole, which could lead to adverse drug reactions in patients. In addition, glucocorticoids should be used according to individual circumstances and adjusted in a timely manner, and blind use might cause adverse drug reactions. Conclusion: Currently, there is no unified understanding of specific therapeutic regimens for ABPM, and many commonly used drugs have potential medication risks. Therefore, clinical pharmacists should fully utilize their professional expertise, actively participate in the treatment of ABPM patients, and carry out pharmaceutical care to ensure the safety and effectiveness of treatment on patients.
  • Analysis of Pharmaceutical Care of Anti-infective Treatment in One Patient with Community-acquired Pneumonia Caused by Methicillin-resistant Staphylococcus Aureus
    CHEN Guo-qiang
    2023, 20(11): 1127-1130. https://doi.org/10.13493/j.issn.1672-7878.2023.11-003
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    Objective: To analyze the pharmaceutical care process of anti-infective treatment in one patient with community-acquired pneumonia caused by Methicillin-resistant Staphylococcus aureus (MRSA), and to provide reference for safe and rational drug use in clinical MRSA infected patients. Methods and Results: The patient was admitted for treatment due to "persistent high fever, cough, sputum, and chest pain for more than a week". After examination, the patient was preliminarily diagnosed as community-acquired pneumonia. Considering the patient's history of use of antibacterial drugs before admission, piperacillin-tazobactam sodium was empirically administered. On Day 4, MRSA was detected in the bronchoalveolar lavage fluid sample; based on the drug susceptibility results, the treatment drug was changed to norvancomycin. Quickly, the body temperature and infection indicators of the patient returned to normal, but the blood creatinine level significantly increased after 2 days, which was considered by the clinical pharmacist as renal injury caused by norvancomycin, thus it was suggested to use linezolid instead. However, a few days later after using linezolid, the patient experienced a significant decrease in white blood cells and neutrophils. Consultation of clinical pharmacists considered it as bone marrow suppression caused by linezolid, and Diyushengbai tablet was recommended for treatment. The telephone follow-up one week later showed that indicators of the patient had returned to normal. Conclusion: For patients with any difficult and complicated disease, clinical pharmacists should not only actively assist in identifying the cause and developing personalized therapeutic regimens during pharmaceutical care, but also pay attention to observing the body response of patients during medication to ensure the effectiveness and safety of treatment.
  • Meta-Analysis of Acute Kidney Injury in Critically Ill Patients Caused by Vancomycin Combined with Piperacillin-Tazobactam Sodium
    ZHOU Ji-qin, XU Bo, WANG Yu-chao
    2023, 20(11): 1131-1135. https://doi.org/10.13493/j.issn.1672-7878.2023.11-004
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    Objective: To explore the occurrence of acute kidney injury (AKI) in critically ill patients caused by vancomycin combined with piperacillin-tazobactam sodium through systematic evaluation, and to provide reference for rational use of antibacterial drugs in clinical practice. Methods: With key words such as vancomycin, piperacillin-tazobactam sodium, acute kidney injury, and nephrotoxicity, literature on the cohort study of AKI in critically ill patients induced by vancomycin combined with piperacillin-tazobactam sodium was searched in Chinese and foreign databases such as PubMed, Embase, CNKI, Chongqing VIP, and Wanfang Databases, and the occurrence of AKI and mortality in patients was analyzed. Results: 6 683 initially retrieved articles were further screened using the inclusion and exclusion criteria, resulting in 10 articles that met the requirements, involving a total of 4 094 patients, including 2 350 cases of patients taking vancomycin combined with piperacillin-tazobactam sodium, and 1 744 cases of patients taking vancomycin combined with other β-lactam drugs. The meta-analysis results showed that the incidence rate of AKI in patients taking vancomycin combined with piperacillin-tazobactam was higher than that in patients taking vancomycin combined with other β-lactam drugs (25.40% vs 10.55%, P<0.05). The mortality rate of patients taking vancomycin combined with piperacillin-tazobactam was slightly lower than that of patients taking vancomycin combined with other β-lactam drugs (13.67% vs 19.54%), but the difference was not statistically significant by comparison (P>0.05). Conclusion: The combination of vancomycin and piperacillin-tazobactam sodium may increase the risk of AKI in critically ill patients. Therefore, clinical attention should be paid to this potential risk when using antibacterial drugs in combination to reduce the occurrence of such adverse events and ensure the medication safety of patients.
  • Analysis of Clinical Diagnosis and Treatment of One Patient with Hypothyroidism Crisis Caused by Anlotinib
    ZHANG Ling, HAN Jia-jun, YU Li
    2023, 20(11): 1136-1140. https://doi.org/10.13493/j.issn.1672-7878.2023.11-005
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    Objective: To analyze the clinical diagnosis and treatment process of one patient with hypothyroidism crisis caused by anlotinib, and to provide reference for the prevention and treatment of hypothyroidism crisis in patients using anlotinib in clinical practice. Methods: The medication status of patients before the onset of hypothyroidism crisis was investigated, combined with relevant literature data, the suspicious drugs that caused this adverse drug reaction were analyzed, and rescue treatment was carried out. Results: Reviewing recent medication changes in the patient, it was considered that the hypothyroidism crisis was caused by anlotinib. Therefore, anlotinib was immediately discontinued and symptomatic treatment was carried out. After 2 weeks, the patient basically recovered and was discharged. Three months later, it was attempted to administer anlotinib to the patient again, but symptoms such as fatigue reappeared and disappeared after discontinuing the drug. Conclusion: Cancer patients may experience a risk of hypothyroidism or even hypothyroidism crisis during the therapy with anlotinib. During this period, clinical attention should be paid to the physical signs of patients and thyroid function should be monitored so as to take timely measures to prevent the development of hypothyroidism crisis.
  • Analysis of Antimicrobial Use Density of Inpatients in a Hospital from 2018 to 2022
    LU Bing, CAI Yan, YANG Hui, LIU Dong, ZENG Ya-xi, ZHANG Man
    2023, 20(11): 1141-1146. https://doi.org/10.13493/j.issn.1672-7878.2023.11-006
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    Objective: To analyze the trend of changes in antimicrobial use density (AUD) among inpatients in a hospital from 2018 to 2022, and to provide reference for the subsequent formulation of antimicrobial drug management systems. Methods: The data of use of antibacterial drugs were collected from inpatients in Zhangjiagang Aoyang Hospital from 2018 to 2022 through the hospital information system, and the overall changes in AUD in the hospital over the past five years, as well as the changes in AUD of different dosage forms, grades, and types of antibacterial drugs were analyzed. Results: Over the past five years, AUD of inpatients in the hospital decreased from 60.34 to 48.04, with a consistently high proportion of AUD for injectable antibacterial drugs (94.71% to 95.74%). The proportion of AUD for restricted grade antibacterial drugs decreased from 70.45% in 2018 to 42.42% in 2022, while the proportion of AUD for non-restricted grade antibacterial drugs increased from 26.87% in 2018 to 52.17% in 2022. Among various types of drugs, the AUD of cephalosporin drugs remained the highest over the past five years, but showed a slow downward trend (from 37.26 in 2018 to 29.54 in 2022), with the AUD of third-generation cephalosporins as the highest. Conclusion: Over the past five years, antibacterial drugs for the hospital inpatients have been increasingly normatively used, and the normative management of antibacterial drugs has achieved certain results. However, there is still an unreasonable phenomenon that the varieties used are relatively concentrated. The administrative department of the hospital should continue to strengthen management to improve the level of rational use of antibacterial drugs in the hospital.
  • Analysis of Rational Use of Antibacterial Drugs in Neurosurgical Patients during Perioperative Period in a Hospital
    HE Jia-jia, LI Jin-liang, YI Yu-guang, WU Jun-bo
    2023, 20(11): 1146-1149. https://doi.org/10.13493/j.issn.1672-7878.2023.11-007
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    Objective: To analyze the rational use of antibacterial drugs in neurosurgical patients during perioperative period in a hospital, and to provide reference for the rational use of antibacterial drugs in clinical surgical patients. Methods: 254 surgical patients admitted to Neurosurgery Department of Pingxiang No. 2 People's Hospital from January 2020 to January 2023 were selected as the research subjects. Information on varieties, timing, and course of prophylactic antibacterial drugs in patients during perioperative period was collected, and the rational use of antibacterial drugs in patients during perioperative period was analyzed according to relevant standards. Results: Among 254 surgical patients, 141 had prophylactic use of antibacterial drugs during perioperative period, with a usage rate of 55.51%; among the drugs, cefazolin (71 cases, 50.35%) and cefuroxime (44 cases, 31.21%) were most commonly used. The timing of medication was mainly 0.5-1 hour before surgery (122 cases, 86.52%), and the course of medication was mostly less than or equal to 24 hours (98 cases, 69.50%). The results of rational drug use reviews showed that there were many unreasonable situations in use of antibacterial drugs by patients, mainly in overlong course of medication (43 cases, with the irrational use rate of 30.50%), followed by improper selection of drug varieties (26 cases, with the irrational use rate of 18.45%) and improper timing of administration (19 cases, with the irrational use rate of 13.48%). Conclusion: There is much irrational use of antibacterial drugs in neurosurgical patients during perioperative period in the hospital, mainly in course of medication, selection of varieties, and timing of administration. The Hospital should strengthen the management of clinical antibacterial drug use to improve the level of rational drug use in clinical practice.
  • Cost-Effectiveness Analysis of Three Empirical Anti-infective Treatment Regimens for Elderly Patients with Non-severe Community-acquired Pneumonia*1
    CHU Ye
    2023, 20(11): 1153-1157. https://doi.org/10.13493/j.issn.1672-7878.2023.11-009
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    Objective: To analyze and compare the cost-effectiveness of three empirical anti-infective treatment regimens for elderly patients with non-severe community-acquired pneumonia (CAP), and to provide reference for clinical and economically effective treatment of elderly patients with non-severe CAP. Methods: 105 elderly patients with non-severe CAP admitted to the First People's Hospital of Nantong from March 2022 to March 2023 were selected as the research subjects. According to different treatment regimens, they were divided into Group A (35 cases, treated with moxifloxacin), Group B (39 cases, treated with cefotaxime-sulbactam sodium), and Group C (31 cases, treated with moxifloxacin + cefotaxime-sulbactam sodium). The efficacy, safety, treatment costs and cost-effectiveness ratio of three groups of patients were compared. Results: The total effective rates of patients in Group A, Group B and Group C after medication treatment were 74.29%, 76.92% and 87.10% respectively, while the incidence rates of adverse drug reaction during the medication period were 5.71%, 2.56% and 3.23% respectively. There was no statistical significance of difference between the total effective rate and the incidence rate of adverse drug reaction after pairwise comparison (P>0.05). The average total hospitalization expenses of patients in Group A, Group B and Group C were (11 337.70±1 348.50) yuan, (14 261.80±1 401.30) yuan and (17 085.70±1 563.40) yuan respectively, while their average total drug expenses were (4 226.00±691.60) yuan, (6 237.50±715.90) yuan and (7 642.70±764.80) yuan respectively. The average total hospitalization expenses and average total drug expenses of Group B and Group C were significantly higher than those of Group A (P<0.05). The cost-effectiveness analysis results showed that the cost-effectiveness ratios (C/E) of patients in Group A, Group B and Group C were 152.61, 185.41 and 196.16 respectively. Conclusion: The efficacy and safety of three empirical anti-infective treatment regimens are basically equivalent for elderly patients with non-severe CAP, and treatment with moxifloxacin alone is more cost-effective.
  • Analysis of Clinical Treatment of One Patient with Condyloma Acuminatum Complicated with Diabetes*1
    JIN Ming, SONG Wei, HE Fang-hua, WU Min-zhi
    2023, 20(11): 1158-1160. https://doi.org/10.13493/j.issn.1672-7878.2023.11-010
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    Objective: To analyze the effect and mechanism of anti-condyloma acuminatum treatment in one patient with condyloma acuminatum complicated with diabetes, and to provide reference for the clinical treatment of such cases. Methods: The patient came to the hospital for treatment because multiple warts appeared around the vulva and gradually increased. After examination, the patient was diagnosed as condyloma acuminatum. Considering that the patient has type 2 diabetes, under the condition of maintaining hypoglycemic treatment, topical imiquimod was combined with thermotherapy for anti-condyloma acuminatum. Results: In Week 3 of treatment, some warts began to shrink, and most warts had been cleared in Week 6 to Week 8. By Week 9, the warts had completely disappeared, so treatment was stopped. Six months later, outpatient reexamination and telephone follow-up showed no recurrence. Conclusion: For this patient with condyloma acuminatum complicated with diabetes, thermotherapy combined with imiquimod has achieved a good therapeutic effect, with no trauma and no recurrence.
  • Correlation Analysis of Red Cell Volume Distribution Width with the Severity of Neonatal Sepsis
    YANG Xin
    2023, 20(11): 1161-1164. https://doi.org/10.13493/j.issn.1672-7878.2023.11-011
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    Objective: To investigate the correlation of red cell volume distribution width (RDW) with the severity of neonatal sepsis, and to provide reference for accurately judging the severity of neonatal sepsis in clinical practice. Methods: 55 child patients with neonatal sepsis admitted to the First Affiliated Hospital of Gannan Medical University from July 2019 to May 2022 were selected as the research subjects. According to the neonatal critical illness score (NCIS), the patients were divided into non-critical group (n=17), critical group (n=33), and extremely critical group (n=5). The correlation between RDW level in the child patients and C-reactive protein (CRP) and the severity of condition was analyzed. Results: The Kruskal-Wallis H test results showed that there were statistically significant differences in RDW and CRP levels among the child patients in non-critical, critical and extremely critical groups after pairwise comparison (P<0.05). The Spearman rank correlation analysis results showed that the RDW level in the child patients with sepsis was positively correlated with their severity of condition (rs=0.746, P<0.001), and also positively correlated with their CRP level (rs=0.779, P<0.001). Conclusion: The severity of neonatal sepsis is closely related to the RDW level in child patients, and the higher the RDW level is, the more severe the condition is.