KANGGANRAN YAOXUE

Archive

  • Select all
    |
  • Research Progress in Predicting Anaphylactic Response of Cephalosporins by Skin Test*1
    LUO Jun, LIU Guo-ping, HUANG Shu-wen, TAN Fu-li, WEI Kun-xuan
    2024, 21(2): 113-117. https://doi.org/10.13493/j.issn.1672-7878.2024.02-001
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Cephalosporins are a class of β-lactam antibacterial drugs formed by linking different side chains with 7-amino-cephalosporanic acid as the mother nucleus. Through continuous iterative research and development, cephalosporins have been continuously optimized in terms of antibacterial spectrum, antibacterial effect and drug safety, etc. However, cephalosporins may induce anaphylactic response and other adverse drug reactions (ADRs) in clinical use. For a long time, ADRs are predicted by skin test in China, but relevant studies have questioned the predictive and application value of skin tests. For this purpose, the relevant studies have been reviewed in terms of the molecular mechanisms and influencing factors of anaphylactic responses caused by β-lactam drugs, the economic value of skin tests, and the current status of skin tests of cephalosporins carried out at home and abroad, etc., so as to provide reference for clinical assessment of the predictive value and application prospects of skin tests for anaphylactic responses of cephalosporins.
  • Research Progress in Biologically Targeted Therapy of Psoriasis*1
    ZHANG Rui, XU Yu-xuan, CAI Xun, WU Min-zhi, LI Jing-jing
    2024, 21(2): 117-122. https://doi.org/10.13493/j.issn.1672-7878.2024.02-002
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Psoriasis is an immune-mediated, polygenic, hereditary skin disease. Although the disease is generally not fatal, it seriously affects the living quality of patients. Presently, the treatment measures of infection are effective, but it is not easy to achieve long-term remission. In recent years, targeted biologics and oral small molecule drugs have become a new focus in the treatment of psoriasis, which can regulate pathological immune responses, reduce the inflammation and recurrence rate more effectively than traditional therapeutic methods. In this article, the pathogenesis of psoriasis, the research and development and clinical applications of targeted biologics and oral small molecule drugs are reviewed to provide the latest perspective for better treatment of psoriasis.
  • Clinical Practice Analysis of Use of Contezolid in Leukopenic Patients with Pre-extensively Drug-resistant Pulmonary Tuberculosis*1
    LI Xiang, ZHANG Hong, KUANG Hao-bin
    2024, 21(2): 123-125. https://doi.org/10.13493/j.issn.1672-7878.2024.02-003
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Objective: To analyze the clinical practice process of using contezolid in a leukopenic patient with pre-extensively drug-resistant (pre-XDR) pulmonary tuberculosis, and provide reference for exploring effective anti-tuberculosis treatment regimens for similar patients with drug-resistant tuberculosis. Methods and Results: The patient was diagnosed with pre-XDR pulmonary tuberculosis 4 months ago and was given anti-tuberculosis treatment with bedaquiline + linezolid + clofazimine + cycloserine + prothionamide; after 20 days of treatment, symptoms such as dizziness, dreaminess, and easy awakening occurred repeatedly; 1 day ago, the symptom of difficulty in falling asleep occurred again, accompanied by fever and right knee joint pain, so the patient was hospitalized. During hospitalization, the patient developed leukopenia for many times, which was considered to be caused by bone marrow suppression with linezolid, and it was not improved after taking Leucogen Tablets. After careful consideration, it was decided to discontinue linezolid and change to contezolid; later, the white blood cell level recovered obviously; in addition, the patient's recurring symptom of difficulty in falling asleep was considered to be toxic reactions of central nerves caused by cycloserine, and the prolongation of Q-T interval during hospitalization was considered to be caused by bedaquiline, so it was decided to discontinue the two drugs. Finally, the patient's anti-tuberculosis regimen was adjusted to contezolid + clofazimine + amikacin + ethambutol + prothionamide, after which the patient no longer experienced uncomfortable symptoms and abnormal indicators. Conclusion: Pre-XDR pulmonary tuberculosis is a disease difficult to treat. The treatment involves multiple and complex medications, and adverse drug reactions are easy to occur, and some adverse drug reactions may lead to serious adverse consequences. Therefore, active clinical interventions should be taken and anti-tuberculosis treatment regimens should be adjusted in a timely manner to ensure the medication safety and treatment effect of patients.
  • Practice Experience of Anti-infective Treatment in an Elderly Patient with Stroke-associated Pneumonia*1
    LIU Yue, GONG Ying
    2024, 21(2): 126-130. https://doi.org/10.13493/j.issn.1672-7878.2024.02-004
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Objective: To analyze the anti-infective treatment process of an elderly patient with stroke-associated pneumonia, and provide reference for the anti-infective treatment in clinically similar patients. Methods and Results: The patient was admitted to the hospital due to "weakness of left limb, unconsciousness, and limb twitching for 4 days". Based on the head CT scan results, the patient was initially diagnosed with stroke, and the chest CT scan results suggested the presence of pulmonary infection, which was considered to be stroke-associated pneumonia, then the patient was empirically treated with ceftazidime; 4 days later, Klebsiella pneumoniae was detected in the sputum specimen (negative for the extended-spectrum β-lactamase test); 6 days later, the patient had high fever suddenly, and the infection indicators such as WBC count, neutrophil percentage, C-reactive protein increased significantly, so ceftazidime was changed to imipenem-cilastatin sodium, but the infection symptoms did not improve significantly; 3 days later, Staphylococcus aureus (resistant to methicillin) was detected in the sputum specimen, so it is recommended to add vancomycin; 6 days later, the infection had not subsided obviously, so vancomycin was adjusted to linezolid, but the infection still recurred from time to time; subsequently, Escherichia coli was detected in the sputum specimen (positive for the extended-spectrum β-lactamase test), so piperacillin-tazobactam sodium was administered; 3 days later, the patient's infection basically subsided and he/she was discharged. Conclusion: Stroke-associated pneumonia is characterized by a complex spectrum of pathogenic bacteria and long-lasting mixed infections, and the pathogenic bacteria are often changeable in the disease process. Therefore, clinical pharmacists should actively explore the pathogenic bacteria of stroke-associated pneumonia, so as to provide targeted anti-infective treatment in a timely manner and ensure that patients recover as quickly as possible.
  • Analysis of Occurrence and Clinical Characteristics of Cycloserine-related Adverse Drug Reactions in Patients with Multidrug-resistant Tuberculosis*1
    GUO Jian, TANG Pei-jun, LIU Jia, ZHOU Fen, ZOU Tao
    2024, 21(2): 131-136. https://doi.org/10.13493/j.issn.1672-7878.2024.02-005
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Objective: To explore the occurrence and clinical characteristics of cycloserine-related adverse drug reactions (ADRs) in patients with multidrug-resistant tuberculosis (MDR-TB), and provide reference for the clinical medication safety of cycloserine in patients with MDR-TB. Methods: 182 MDR-TB patients admitted to the Fifth People's Hospital of Suzhou from January 1, 2018 to December 31, 2021 were selected as the research subjects, and the information such as patient's age, gender, occupation, tuberculosis type, treatment outcome, use of cycloserine, and occurrence of related ADRs was collected, focusing on analyzing the occurrence and clinical characteristics of cycloserine-related ADRs in MDR-TB patients. Results: After excluding those who were lost to follow-up, died, and did not use cycloserine from 182 MDR-TB patients, there were only 167 cases. Among them, 134 cases were successfully treated, with a treatment success rate of 80.24%; among 167 patients, ADRs occurred in 10 cases, with the incidence of 5.99%. The Naranjo's Assessment Scale showed that the correlation scores between 10 cases of ADRs and cycloserine were 5-8 points, i.e. the correlation was "very likely"; the occurrence time of 10 cases of ADRs was 4 to 361 days (median: 67.5 days) after medication, and their clinical manifestations were the toxicity symptoms of central nerves (such as suicidal tendency, insanity, severe insomnia, anxiety, depression, lethargy, etc.). After cycloserine was discontinued or the dosage of vitamin B6 was increased, the toxicity symptoms of central nerves of 10 patients were relieved or disappeared. Conclusion: The cycloserine-based anti-tuberculosis treatment regimen has a good curative effect on MDR-TB patients; meanwhile, the incidence of cycloserine-related toxicity symptoms of central nerves is relatively low, but the symptoms are more serious. Therefore, clear instructions should be given during medication propaganda and education to patients to ensure the medication safety of patients.
  • Analysis of Diagnosis and Treatment of Male Patients with Erythema Multiforme Drug Eruption on External Genitalia Caused by Artificial Bezoar Metronidazole Capsules
    CHU Li-juan, WU Tao, WANG Rong-hua
    2024, 21(2): 136-138. https://doi.org/10.13493/j.issn.1672-7878.2024.02-006
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Objective: To analyze the diagnosis and treatment process of one male patient with erythema multiforme drug eruption on the external genitalia caused by artificial bezoar metronidazole capsules, and provide reference for the clinical medication safety of such drugs. Methods and Results: The patient purchased and took artificial bezoar metronidazole capsules on his own because of toothache. However, on the second day, rice-to-bean-sized erythemas were found on his external genitalia, which were densely and symmetrically distributed with slight itching, so he discontinued the drugs on his own. Nonetheless, his symptoms were not relieved after discontinuing medication for many days, and the skin lesions gradually increased, and erosion and exudation appeared on the surfaces, so he was admitted to the hospital for treatment. After admission, the patient was given anti-inflammatory and anti-infective treatment. After 2 weeks, the patient's erythema basically disappeared; one month later, the patient's skin lesions were basically healed; during the period, the doctor used the Naranjo's Assessment Scale to investigate the correlation between erythema multiforme drug eruption and artificial bezoar metronidazole capsules. The assessment score was 6, i.e. the correlation was "very likely". Conclusion: It is rare for drug eruptions caused by artificial bezoar metronidazole capsules to appear on the external genitalia only without involving other body parts. Medication instructions should be given during clinical propaganda and education to facilitate early identification and early treatment for patients.
  • Epidemiological Analysis of Anaphylactic Responses Caused by Atocaine Hydrochloride and Epinephrine Tartrate Injection Based on Literature
    PAN Li-li
    2024, 21(2): 139-143. https://doi.org/10.13493/j.issn.1672-7878.2024.02-007
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Objective: To analyze the epidemiological characteristics of anaphylactic responses caused by atocaine hydrochloride and epinephrine tartrate injection (AHETI) through literature search, and provide reference for the clinical medication safety of this drug. Methods: By using the KEY WORDS such as "atocaine hydrochloride and epinephrine tartrate injection", "anaphylaxis or anaphylactic response", "adverse drug reaction", all relevant case documents as of December 31, 2022 in Chinese and foreign databases such as CNKI, Wanfang Database, Chongqing VIP, PubMed, Springer, and Elsevier were searched. The information such as age, gender, disease of relevant cases, usage and dosage of AHETI, as well as occurrence time, severity, clinical manifestations and outcomes of anaphylactic responses was collected to analyze the epidemiological characteristics of anaphylactic responses caused by AHETI. Results: A total of 22 relevant case documents were searched in databases, involving 23 cases; of which, most cases were females (18 cases, 78.26%), elder than 20 to 40 years old (12 cases, 52.17%); 23 cases were mainly diagnosed with pulpitis (6 cases, 26.09%), chronic periodontitis (5 cases, 21.74%) and tooth extraction (4 cases, 17.39%); the occurrence time of anaphylactic responses was mainly concentrated within 10 minutes after medication (12 cases, 52.17%), and the main organs involved in anaphylactic responses included the skin and its appendages, neuromuscular, circulatory system and respiratory system. After symptomatic treatment, all 23 patients got better. Conclusion: Anaphylactic responses caused by AHETI have characteristics in terms of the patient's age and gender, occurrence time and clinical manifestations. Therefore, active attentions should be paid to them and protective measures should be taken to ensure the medication safety of patients.
  • Analysis of Clinical Efficacy of Ceftazidime and Avibactam Sodium in Patients with Carbapenem-resistant Gram-negative Organisms Infection and Its Influencing Factors*1
    MAO Jiao-jiao, CAO Guo-wen, ZHU Zhu, TAO Hong, XU Feng
    2024, 21(2): 144-151. https://doi.org/10.13493/j.issn.1672-7878.2024.02-008
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Objective: To analyze the clinical efficacy of ceftazidime and avibactam sodium in patients with carbapenem-resistant gram-negative organisms (CRO) infection and its influencing factors, and provide reference for the clinical use of ceftazidime and avibactam sodium. Methods: 48 patients with CRO infection who were admitted to the Second Affiliated Hospital of Soochow University from September 2019 to May 2022 and treated with ceftazidime and avibactam sodium were selected as the research subjects, and the information such as patient's age, gender, infection type and state of pathogenic bacteria, use of antibacterial drugs, other auxiliary treatment operations, treatment outcomes was collected to analyze the clinical efficacy of ceftazidime and avibactam sodium in patients with CRO infection and related influencing factors. Results: Among 48 patients with CRO infection, most of them had multi-site infection (28 cases, 58.33%), the infection type was mainly pulmonary infection (29 cases, 60.42%), and the pathogenic bacteria were mainly Klebsiella pneumoniae (39 cases, 81.25%) and Pseudomonas aeruginosa (21 cases, 43.75%); most patients were treated with drug combinations (29 cases, 60.42%), and the combined drug was mainly carbapenems (17 cases, 58.62%). The treatment outcomes of ceftazidime and avibactam sodium showed that 33 cases (68.75%) were clinically effective, and 15 cases (31.25%) were ineffective. The regression analysis results showed that the treatment failure of patients with CRO infection was related to the infection type, whether patients received continuous renal replacement therapy (CRRT), whether patients had a history of polymyxin exposure a month before treatment, whether carbapenems were combined, and the course of treatment (P<0.05), of which, receipt of CRRT was an independent risk factor for the treatment failure of patients (P<0.05); in terms of liver injury, the treatment with ceftazidime and avibactam sodium did not increase the ALT and AST levels of patients significantly (P>0.05). Conclusion: ceftazidime and avibactam sodium are of great significance in the treatment of patients with CRO infection and can be used as one of salvage treatment options. However, CRRT may interfere with the therapeutic effect of ceftazidime and avibactam sodium, and the usage and dosage of ceftazidime and avibactam sodium can be explored to improve the success rate of treatment.
  • Investigation and Analysis of Azithromycin Prescriptions in Outpatient Department of a Hospital
    TAN Jun, WANG Jian, ZHANG Gui-fen
    2024, 21(2): 151-157. https://doi.org/10.13493/j.issn.1672-7878.2024.02-009
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    Objective: To investigate the clinical characteristics of azithromycin prescriptions in the outpatient department of a hospital and conduct special comments on azithromycin prescriptions, and provide reference for the clinical rational use of azithromycin. Methods: By using the hospital information system, 190 729 prescriptions from the outpatient department of Changshu No. 1 People's Hospital from August 1 to October 31, 2023 were retrieved as the research materials, and the information in the prescriptions such as patient's age, gender, department, diagnosis, type, quantity and amount of drugs was collected, and special comments on azithromycin prescriptions were performed according to the Measures on Administration of Prescriptions, the Management Standard of Comments on Hospital Prescriptions (Trial), package inserts and related treatment guidelines and other authoritative data, to analyze the clinical characteristics and irrational use of azithromycin prescriptions. Results: Among 190 729 prescriptions, there were 23 780 prescriptions for antibacterial drugs, including 4 968 azithromycin prescriptions (20.89%), and the dosage form of azithromycin was mainly dry suspension (3 588 prescriptions, 72.22%). Among 4 968 azithromycin prescriptions, in terms of department distribution, the pediatrics department and neonatology department were dominated (4 340 prescriptions, 87.36%); in terms of age distribution, minors (below 18 years old) were dominated (4 455 prescriptions, 89.67%); in terms of diagnosis of patients, respiratory diseases were dominated (4 409 prescriptions, 88.75%); in terms of quantity of drugs, 2 types (1 548 prescriptions, 31.16%) and 3 types (1 172 prescriptions, 23.59%) were dominated; in terms of drug amount, antibacterial drugs (172 046 yuan, 28.01%) and Chinese patent medicines (164 478 yuan, 26.78%) were dominated. Among 4 968 azithromycin prescriptions, there was combination with other antibacterial drugs in 510 prescriptions, of which combination with cephalosporins was the most (492 prescriptions, 96.47%). The comments on prescriptions revealed that 330 prescriptions contained irrational drug use (irrational rate of 6.64%), of which the main irrational reasons were more than 5 types of prescription drugs (137 prescriptions, 41.52%) and inappropriate usage and dosage (94 prescriptions, 28.48%). Conclusion: Azithromycin is widely used in the outpatient department of hospital, and the overall medication is rational, nut the extraordinary prescription is more prominent. Therefore, relevant training and management should be strengthened in hospitals to improve the level of clinical rational drug use.