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  • Research Progress in Pharmacological Effects of Ophiopogonin D
    SUN Yan, ZHU Li-hong, CHEN Jun-yi, LI Rui-hua, ZHAO Fang-li, ZHOU Jing-yi
    2024, 21(1): 1-5. https://doi.org/10.13493/j.issn.1672-7878.2024.01-001
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    Ophiopogonin D is steroid saponins extracted from the Chinese herb Ophiopogonis Radix, and has a wide range of pharmacological effects such as anti-inflammation, anti-tumor, lipid lowering, myocardial protection, neuroprotection, gastrointestinal protection, and regulation of bone metabolism. In this article, researches on the pharmacological effects of ophiopogonin D conducted in recent years are reviewed and analyzed, to provide reference for its further development.
  • Research Progress in Pharmacological Effects of Berberine against Brain Tumor and Head-Neck Tumor
    ZHANG Ming-fa, SHEN Ya-qin
    2024, 21(1): 6-13. https://doi.org/10.13493/j.issn.1672-7878.2024.01-002
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    Berberine has a wide range of pharmacological activities. In addition to anti-inflammatory, anti-infectious, hypoglycemic, blood-lipid regulating and cardioprotective functions, it has significant anti-tumor effects on gastric cancer, breast cancer, bladder cancer, liver cancer, etc. It is a potential anti-tumor drug. In this article, the pharmacological effects of berberine against head-neck tumors such as thyroid cancer, nasopharyngeal cancer, oral squamous cell carcinoma, tongue cancer, laryngeal cancer and adenoid cystic carcinoma, and brain cancer and the related mechanisms of action are reviewed and analyzed, to provide theoretical support for the subsequent development of berberine.
  • Content Determination and Analysis of Imipenem, Meropenem, Vancomycin and Teicoplanin in Human Serum Based on LC-MS/MS*1
    WANG Yue-yuan, XIANG Zheng, QU Yu-chen, FAN Kai, SU Cun-jin
    2024, 21(1): 14-18. https://doi.org/10.13493/j.issn.1672-7878.2024.01-003
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    Objective: To establish a method for simultaneous and rapid determination of imipenem, meropenem, vancomycin and teicoplanin in human serum based on liquid chromatography-tandem mass spectrometry (LC-MS/MS), and provide reference for the therapeutic drug monitoring in clinically infected patients. Methods: By using Agilent 1260 series liquid chromatograph and API 4000 triple tandem quadrupole mass spectrometer, Phenomenex KINETEX XB-C18 (2.6 μm, 3×50 mm) as the chromatographic column, 0.1% formic acid-water and pure acetonitrile as the mobile phase, electrospray ionization (ESI), multiple reaction monitoring (MRM) combined with positive ion mode as the mass spectrometry conditions, a method for simultaneous and rapid determination of 4 antibacterial drugs (imipenem, meropenem, vancomycin and teicoplanin) in human serum was established. Results: The determination results showed that there were no interference peaks at the retention time of 4 antibacterial drugs and 2 internal standard substances; 4 antibacterial drugs had good linear relationships within their respective concentration ranges, and their correlation coefficients (r2) were all greater than 0.99, and the S/N of the lowest limit of quantification were all greater than 10; the precision and accuracy test results showed that the inter-day and intra-day relative standard deviations (RSDs) of determination results of 4 antibacterial drugs were all less than 10.00%, and their relative errors (REs) were all within ±10.00%; the recovery rates of determination results of 4 antibacterial drugs were all between 85.00% and 115.00%; the review of stability showed that the REs of determination results of 4 antibacterial drugs were all within ±10.00% at different temperatures and storage times. Conclusion: LC-MS/MS can determine the contents of 4 antibacterial drugs (imipenem, meropenem, vancomycin and teicoplanin) in serum simultaneously and rapidly, and has high precision and accuracy and strong stability; therefore, it can provide better support for clinical therapeutic drug monitoring.
  • Analysis of Clinical Diagnosis and Treatment of a Patient with Rare Bloodstream Infection Caused by Malassezia Restricta*1
    ZHU Xiao-hua, QI Zhi-gang
    2024, 21(1): 19-22. https://doi.org/10.13493/j.issn.1672-7878.2024.01-004
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    Objective: To analyze the clinical diagnosis and treatment process of a patient with rare bloodstream infection caused by Malassezia restricta, and provide reference for the clinical diagnosis and treatment of such rare infectious diseases. Methods and Results: The patient had recurrent fever after being scratched by a cat 2 weeks ago, and continued to have fever after admission. The examination showed that the WBC count and procalcitonin in serum were normal, and only the C-reactive protein (CRP) increased. According to the patient's clinical symptoms, the respiratory tract and urinary tract infections were clinically ruled out, and no other obvious foci of infection were found. Clinically, azithromycin was given empirically; 2 days later, the fungal D-glucan test results were abnormal (222.53 pg/mL); the clinical pharmacist consultation revealed that the patient had recently suffered from poor control of blood glucose in diabetes and had taken glucocorticoids, so his/her immune functions might be poor. Based on the patient's previous examination results, it was suspected that the patient's fever was possibly caused by bloodstream infection when fungi invaded the blood as a result of cat scratch, so it was suggested to add fluconazole for antifungal treatment; on the 2nd day, the patient's body temperature dropped apparently, and on the 3rd day, the next-generation sequencing results of the patient's blood samples showed that the bacterium was Malassezia restricta (sequence number: 29), which basically confirmed the judgment of the clinical pharmacist; finally, the patient was discharged from the hospital 10 days after treatment with fluconazole. Conclusion: For any patient with fever of unknown origin, clinicians and pharmacists should accurately determine the patient's infection site and possible pathogenic bacteria according to the patient's clinical manifestations and various examination results, as well as feedback from empirical anti-infective treatment, so as to provide more targeted and effective treatment for the patient.
  • Pharmaceutical Care of Anti-infective Treatment in a Patient with Rickettsia-associated Septic Shock
    CHEN Shi-ping, YANG Yu, DAI Rong, GONG Lei
    2024, 21(1): 23-26. https://doi.org/10.13493/j.issn.1672-7878.2024.01-005
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    Objective: To analyze the pharmaceutical care process of anti-infective treatment in a patient with Rickettsia-associated septic shock, and provide reference for the diagnosis and treatment of serious infection caused by Rickettsia in clinical practice. Methods and Results: The patient developed fever and dry cough without obvious inducement 6 days ago, and dyspnea 1 day ago. The examination at admission showed that the procalcitonin (3.23 ng/mL) and C-reactive protein (120.4 mg/L) levels increased obviously, so the clinician gave empiric anti-infective treatment with imipenem-cilastatin sodium, levofloxacin, and ribavirin; on the 2nd day, the patient showed symptoms of septic shock, and after consultation with the clinical pharmacist, it was suggested that the anti-infective treatment regimen was adjust to meropenem and azithromycin; on the 4th day, the metagenomic next-generation sequencing (mNGS) test results of the patient's blood samples showed positive for Rickettsia japonica, while the mNGS results of the sputum samples showed positive for Klebsiella pneumoniae, Streptococcus mitis, Streptococcus pneumoniae and Candida tropicalis. The clinical pharmacists believed that Rickettsia japonicum was pathogenic bacteria and the others were colonized bacteria, so it was suggested that the anti-infective treatment regimen was changed to doxycycline, but the clinician added piperacillin-tazobactam sodium for the safety purpose; 3 days later, the patient's body temperature returned to normal, infection indicators and related symptoms were obviously improved, and the patient was discharged from the hospital soon. Conclusion: Septic shock caused by Rickettsia is relatively rare, so it is easily ignored in clinical practice. When carrying out the pharmaceutical care, clinical pharmacists should comprehensively analyze the patient's clinical manifestations, examination results and medication history, assist clinicians in identifying the pathogenic bacteria of infection as quickly as possible, so that the targeted anti-infective treatment is carried out to ensure rapid recovery of the patient.
  • Analysis of Clinical Characteristics and Influencing Factors of Adverse Drug Reactions of Different Severity Caused by Intravenous Azithromycin in a Children's Hospital*1
    LIU Gong-lian, WANG Yan, CHEN Yan-hua, DONG Jing-jing
    2024, 21(1): 27-31. https://doi.org/10.13493/j.issn.1672-7878.2024.01-006
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    Objective: To analyze the clinical characteristics and influencing factors of children with adverse drug reactions (ADRs) of different severity caused by intravenous azithromycin in a hospital, and provide reference for safe and rational use of azithromycin in clinical practice. Methods: The reports of ADRs caused by intravenous azithromycin in 264 patients that were reported by Wuxi Children's Hospital Affiliated to Jiangnan University to the National Adverse Drug Reaction Monitoring System from December 2016 to December 2021 were selected as the research data, and the information such as child age, sex, body weight, examination indicators and severity of ADRs, as well as usage, dosage and combined use of azithromycin was collected, to analyze the clinical characteristics and influencing factors of children with ADRs of different severity caused by azithromycin. Results: According to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0, among the ADR reports of 264 cases, 120 cases were of severity grade I (45.45%), 91 cases were of severity grade II (34.47%), 51 cases were of severity grade III (19.32%), and 2 cases were of severity grade IV (0.76%). Compared with patients with grade I ADRs, those with grade II and above ADRs were significantly younger and had smaller body weights (P<0.05), and their aspartate transaminase (AST) levels were significantly higher (P<0.05); in terms of medication, compared with patients with grade I ADRs, those with grade II and above ADRs had a higher proportion of azithromycin combined with ambroxol and number of combined drugs more than 3 (P<0.05). The Logistic regression analysis results showed that age, body weight, AST level, azithromycin combined with ambroxol, and number of combined drugs more than 3 were the influencing factors for children with grade II and above ADRs (P<0.05). Conclusion: Children with grade II and above ADRs caused by intravenous azithromycin have younger age, lower body weights, higher AST levels, more combined use of azithromycin and ambroxol, and more number of combined drugs more than 3. These factors are important influencing factors for the occurrence of grade II and above ADRs in children using intravenous azithromycin. Therefore, clinical monitoring and management of high-risk children should be strengthened to ensure the safe medication of children.
  • Epidemiological Analysis of Cephalosporin-related Adverse Drug Reactions in a Hospital*1
    ZHOU Ai-chun, LIU Ji-heng, WEN Long, YU Hui, LIU Meng-jiao, LIU Xiao-hui
    2024, 21(1): 32-36. https://doi.org/10.13493/j.issn.1672-7878.2024.01-007
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    Objective: To analyze the epidemiological characteristics of cephalosporin-related adverse drug reactions (ADRs) in a hospital, and provide reference for the clinical safe use of cephalosporins. Methods: The ADR reports of 1 074 patients reported by Qiyang Traditional Chinese Medicine Hospital to the National Adverse Drug Reaction Monitoring System from January 1, 2012 to December 31, 2021 were selected as the research data, and the information such as drug type, usage and dosage, and patient's age, sex and clinical manifestations was collected, to analyze the epidemiological characteristics of cephalosporin-related ADRs. Results: In the ADR reports of 1 074 patients, 392 involved antibacterial drugs, including 203 related to cephalosporins; among 203 cases of cephalosporin-related ADRs, the patients were mainly between 18 and less than 45 years (68 cases, 33.50%) and between 45 and less than 65 years (49 cases, 24.14%), and the types involved were mainly the third-generation cephalosporins (152 cases, 74.87%), among which the main varieties involved were ceftazidime for injection (51 cases, 25.12%) and cefotaxime for injection (42 cases, 20.69%); in terms of organs involved, 203 cases of cephalosporin-related ADRs mainly involved the skin and its appendages (163 cases, 80.30%), with the main manifestations of rash, skin itching, urticaria, skin redness and erythema; 30 in 203 cases of cephalosporin-related ADRs were severe ADRs. The univariate analysis results showed that the occurrence of severe ADRs was related to the patient's age and route of drug administration (P<0.05). Conclusion: Cephalosporins play an important role in ADRs related to antibacterial drugs, with obvious characteristics in terms of patient's age, drug type and route of drug administration, and the patient's age and route of drug administration may also be related to the severity of ADRs. Therefore, clinical management and monitoring of patients at risk should be strengthened to ensure the safe medication of patients.
  • Innovative Practice of Constructing a Safe Medication Mode of Linezolid Based on PDCA Cycle Method*1
    SHI Lu, TANG Lian, DUAN Lu-fen, LI Jing-jing, LU Jian, ZHUANG Zhi-wei, YUAN Yun-long, FENG Zong-tai, XUE Hong-zhi, XU Jin-hui, CHEN Wen-qiang
    2024, 21(1): 40-47. https://doi.org/10.13493/j.issn.1672-7878.2024.01-009
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    Objective: To estabilish a safe medication mode of linezolid by using PDCA cycle management method, and then optimize the dosage regimen of linezolid and improve the standard-reaching rate of steady-state minimum concentration (Cminss) and area under the plasma concentration-time curve from time 0-24 h (AUC24) within the target range, so as to reduce adverse drug reactions (ADRs) such as linezolid induced thrombocytopenia (LIT) in critical illness patients. Methods: 199 critical illness patients, treated with linezolid and monitored forCminss, were selected from the Intensive Care Unit and Emergency Intensive Care Unit of the Affiliated Suzhou Hospital of Nanjing Medical University from July 2020 to June 2022. Patients who did not use PDCA cycle management method for pharmaceutical care from July 2020 to June 2021 were set as the control group (n=87), and patients who used PDCA cycle management method for pharmaceutical care from July 2021 to June 2022 were set as the intervention group (n=112). The adjustment of the dosage regimen of linezolid, the standard-reaching rate of Cminss and AUC24, and the occurrence of ADRs such as LIT were analyzed and compared between the two groups. Results: The proportion of patients adjusting linezolid's dosage regimen in the intervention group was much higher than that in the control group (53.57% vs 29.88%,P=0.012). The proportion of patients in the intervention group with Cminss in the target range of 2-7 mg/L after the initial regimen of linezolid was significantly higher than that in the control group (46.43% vs 12.64%,P<0.001), while the proportion of patients in the intervention group with Cminss>10 mg/L after the initial regimen of linezolid was significantly lower than that in the control group (25.00% vs 58.62%,P<0.001). The proportion of linezolid's AUC24 within 100~300 mg·h/L in the intervention group was significantly higher than that in the control group (51.78% vs 26.43%,P=0.012), while the proportion of linezolid's AUC24>350 mg·h/L after the initial regimen in the intervention group was significantly lower than that in the control group (14.94% vs 55.35%,P<0.001). After treatment with linezolid, 21 cases of LIT occurred in the control group, while only 12 cases in the intervention group, the difference was statistically significant (P=0.003). The incidence of other ADRs was also lower in the intervention group than in the control group (0.89% vs 6.90%,P=0.031). Conclusion: Through the implementation of PDCA cycle management, the standard-reaching rate of linzolid Cminss and AUC24 was significantly improved, while the incidence of LIT and other ADRs was significantly decreased, thus increasing the medication safety of patients.
  • Analysis of Rational Use of Carbapenem Antibacterial Drugs in a Hospital
    HAN Hong-yu, CHEN Yao-sheng, ZHANG Ying-jie, DUAN Xiao-ying
    2024, 21(1): 48-51. https://doi.org/10.13493/j.issn.1672-7878.2024.01-010
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    Objective: To analyze the rational use of carbapenem antibacterial drugs in a hospital and provide reference for promoting the clinical rational use of carbapenems. Methods: The carbapenem medical orders of inpatients in Zhengzhou Second People's Hospital from July to December 2022 were selected as the research data, and the information such as patient's clinical diagnosis and examination results, type of carbapenem used, usage and dosage, course of treatment and drug combination was collected. The rational use of carbapenems in medical orders was evaluated and analyzed according to the Detailed Rules for the Clinical Application Evaluation of Carbapenem Antibacterial Drugs. Results: From July to December 2022, 84 patients used carbapenems in the hospital, and the clinical departments involved mainly included Department of Critical Care Medicine (33 cases, 39.29%), and Department of Respiratory and Critical Care Medicine (12 cases, 14.29%) and Department of Gastroenterology II (10 cases, 11.90%); the results of comments on the rational drug use revealed that there were a total of 41 irrational drug uses in 84 patients, mainly including inappropriate indications (16 items, 39.02%) and no pathogenic testing before medication (14 items, 34.15%). Conclusion: Currently, there are still many unreasonable phenomena in the use of carbapenem antibacterial drugs in inpatients in the hospital. The administrative department should strengthen the clinical training and management to improve the rational drug use and ultimately ensure the medication safety and effectiveness for patients.
  • Analysis of Prophylactic Use of Perioperative Antibacterial Drugs in Patients Undergoing Class I Incision Surgery in a Hospital
    ZHANG Qian
    2024, 21(1): 52-54. https://doi.org/10.13493/j.issn.1672-7878.2024.01-011
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    Objective: To analyze the prophylactic use of perioperative antibacterial drugs in patients undergoing Class I incision surgery in a hospital, and provide reference for the standardized and rational use of antibacterial drugs in clinical perioperative patients. Methods: 258 patients undergoing Class I incision surgery admitted to Fengxin County People's Hospital from January 2021 to October 2022 were selected as the research subjects, and the information such as patient's age, sex, clinical diagnosis, department, and selection of antimicrobial drugs, timing of administration and medication course was collected, to analyze the characteristics of perioperative medication of antimicrobial drugs, and give comments on the rational drug use according to the Guiding Principles for Clinical Application of Antibacterial Drugs and other authority data. Results: Among 258 patients undergoing Class I incision surgery, 95 (36.82%) had prophylactic use of antibacterial drugs during the perioperative period, with the highest the proportions in the orthopedics (35 cases, 35.79%) and general surgery (25 cases, 26.32%); among 95 patients, the main antibacterial drugs used were cefazolin (50 cases, 52.63%) and clindamycin (15 cases, 15.79%); the results of comments on the rational drug use showed that 7 (7.37%) of 95 patients used drugs without indications, 16 (16.84%) were administered more than 2 hours or less than 0.5 hour before surgery, and 13 (13.68%) had a medication course of more than 24 hours. Conclusion: The prophylactic use of perioperative antibacterial drugs in patients undergoing Class I incision surgery in the hospital is generally reasonable, but there are still many problems in terms of indications, variety selection, timing of administration, and medication course. The hospital administrative department should strengthen the clinical training and management to reduce the occurrence of irrational drug use and ensure the medication safety for perioperative patients.