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  • Research Progress in Novel β-Lactam/β-Lactamase Inhibitor Compound Preparation Cefepime-Taniborbactam Sodium*1
    HOU Ju, XIA Yan-zhe, LI Jia
    2024, 21(10): 983-987. https://doi.org/10.13493/j.issn.1672-7878.2024.10-001
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    Bacterial resistance is a global public health problem, especially carbapenem-resistant Gram-negative bacteria (CR-GNB) have more serious harm. Clinically, there are very limited methods for prevention and treatment of CR-GNB infection, so novel antibacterial drugs are urgently needed. Cefepime-taniborbactam sodium is a compound preparation composed of the fourth-generation cephalosporin cefepime and the novel broad-spectrum β-lactamase inhibitor taniborbactam sodium, and has direct inhibitory activity against four types of β-lactamases (types A, B, C and D), so it may have good antibacterial effects on CR-GNB and other drug-resistance bacteria. In this article, the mechanism of action, pharmaceutical properties, antibacterial activity, clinical study, enzyme inhibition/antibacterial spectrum of cefepime and taniborbactam sodium are reviewed, so as to provide reference for the rational clinical use of cefepime-taniborbactam sodium.
  • Pharmaceutical Care of One Pregnant Woman with Immune Abnormality and Listeria Monocytogenes Bloodstream Infection during Anti-infection Treatment*1
    HE Sai-zhu, LI Jia, XIA Yan-zhe
    2024, 21(10): 988-993. https://doi.org/10.13493/j.issn.1672-7878.2024.10-002
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    Objective: To analyze the pharmaceutical care process of one pregnant woman with immune abnormality and Listeria monocytogenes bloodstream infection during anti-infection treatment, and provide reference for the clinical treatment of pregnant women complicated with Listeria monocytogenes infection. Methodsand Results: A pregnant woman (31 years old, 16+4 weeks of menelipsis) was admitted to the hospital due to fever for 6 days; after admission, bilateral blood culture was performed and cefuroxime was given for empirical anti-infection treatment. On the next day, Listeria monocytogenes was detected from the blood culture, which was sensitive to penicillin, ampicillin and meropenem. Since ampicillin was not available in the hospital and piperacillin-tazobactam sodium was speculated to be effective based on the bacterial drug susceptibility results and the antibacterial spectrum of antibacterial drugs, the anti-infection treatment regimen was switched to piperacillin-tazobactam sodium. After 2 days, the patient had no fever, but Listeria monocytogenes was still detected from the blood culture. About 2 weeks later, the patient had fever again, the influenza A virus antibody IgM was detected positive and the influenza B virus antibody IgM was detected weakly positive. The patient and her family decided to terminate the pregnancy in view of the patient's complex conditions. After induced abortion, the patient received infusions of piperacillin-tazobactam sodium for 3 times and developed symptoms such as muscle soreness, which was suspected to be related to piperacillin-tazobactam sodium, so penicillin was used instead; 4 days later, amoxicillin-clavulanate potassium was taken orally, but the patient had rash and itching after administration, which were considered as drug-induced rash. Because the patient had terminated the pregnancy, compound sulfamethoxazole was used instead; the patient's condition improved soon and she was discharged from the hospital. The clinical pharmacist recommended continued treatment with compound sulfamethoxazole and regular follow-up visits. Conclusion: For special populations such as pregnant women with Listeria monocytogenes infection, clinical pharmacists should fully consider patients' specific conditions, assist doctors in formulating a more personalized treatment regimen and adjust it in a timely manner with the disease condition changes, to ensure the safe medication and treatment effects for patients.
  • Anti-infection Treatment and Pharmaceutical Care of a Patient with Chronic Sinusitis Secondary Brain Abscess
    LU Xian, HAN Guo-qiang, QIAN Xin
    2024, 21(10): 994-999. https://doi.org/10.13493/j.issn.1672-7878.2024.10-003
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    Objective: To analyze the pharmaceutical care process of one patient with chronic sinusitis and secondary brain abscess during anti-infection treatment, and provide reference for the diagnosis and treatment of similar patients in clinical practice. Methodsand Results: A patient visited the hospital for treatment due to "fever and headache for 8 days". According to the patient's head CT results and symptoms, the patient was initially diagnosed with viral meningoencephalitis, so acyclovir was given empirically. Two days later, the patient still had fever and headache, and bacterial infection could not be ruled out, so ceftriaxone was added. Later, the MRI showed that the patient's left maxillary sinus, ethmoid sinus, frontal sinus inflammations were located on the same side as the brain abscess lesions. In addition, metagenomic next-generation sequencing of cerebrospinal fluid reported Porphyromonas endodontalis and Prevotella oralis. As the patient had chronic sinusitis, the possibility of abscess originating from the paranasal sinus could not be ruled out, so ceftriaxone was discontinued and meropenem was used instead; subsequently, the patient's body temperature dropped, but the CT scan indicated the possibility of brain herniation, then the patient received surgical treatment. Considering that intracranial infection was mostly caused by Gram-positive bacteria, vancomycin was added empirically. Later, Streptococcus constellatus was detected in the intracranial purulent secretion specimens. Three days later, the plasma concentration of vancomycin was lower than the recommended value lower limit, then the dosing frequency was adjusted and ornidazole was added. After treatment for more than one month, the patient recovered well. Conclusion: For the intracranial infection in patients with chronic sinusitis, full consideration should be given to the possibility of disseminated infections of common bacteria in the mouth and nose and etiological examinations should be carried out actively. The treatment should cover possible common bacteria as much as possible to guarantee the recovery of patients.
  • Case Analysis and Literature Review of Polymyxin B-Induced Neuromuscular Block
    WU Dan, LI Li-xin, GUO Dong-jie
    2024, 21(10): 1000-1004. https://doi.org/10.13493/j.issn.1672-7878.2024.10-004
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    Objective: To analyze the clinical characteristics of polymyxin B-induced neuromuscular block based on actual cases and relevant literature reports, and provide reference for the clinical medication safety of polymyxin B. Methods: The clinical characteristics for occurrence of one patient with polymyxin B-induced neuromuscular block were collected, and the relevant literatures were searched from Chinese and foreign databases using "polymyxin", "neurotoxicity" or "neuromuscular block" as keywords. The relevant data of the reported cases were collected, and the clinical characteristics of polymyxin B-induced neuromuscular block were analyzed. Results: A total of 6 valid articles were searched, involving 8 cases. Among 9 cases with polymyxin B-induced neuromuscular block, 8 cases occurred within 5 days after the first medication, with the main clinical manifestations of dyspnea (7 cases) and perioral abnormality (5 cases). Six patients with dyspnea underwent endotracheal intubation or tracheotomy. After treatment, one case died of septic shock, and the rest cases improved or were cured. Conclusion: Neuromuscular block is a rare adverse reaction of polymyxin B. Although rare, its consequences are serious, especially special attention should be paid to dyspnea. Therefore, clinical monitoring of the use of polymyxin B should be strengthened to ensure the safe medication for patients.
  • Analysis of Clinical Characteristics of Adverse Drug Reactions Related to Anti-infective Drugs in a Hospital*1
    HU Xiao-qian
    2024, 21(10): 1005-1009. https://doi.org/10.13493/j.issn.1672-7878.2024.10-005
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    Objective: To analyze the clinical characteristics of adverse drug reactions (ADRs) related to anti-infective drugs in the hospital and provide reference for the clinical safe use of anti-infective drugs. Methods: The anti-infective drug related ADR reports of 107 patients reported by Anyang District Hospital of Puyang City from January 2022 to December 2023 were selected as research data. The information such as patient age, gender, type of ADR reports, type and dosage form of drugs, organs involved and clinical manifestations was collected to analyze the clinical characteristics of anti-infective drug related ADRs. Results: Among the ADR reports of 107 cases, the report type was mainly "general" (97 cases, 60.65%), and the reports of "new and general" and "serious" types only involved 6 cases and 4 cases respectively. In terms of gender, the number of male patients with ADRs was slightly more than that of female patients (56 cases vs 51 cases); in terms of age, most patients were over 50 years old (71 cases, 66.36%). In terms of drug types, the drugs involved in ADRs were mainly quinolones (48 cases, 44.86%) and cephalosporins (20 cases, 18.69%); in terms of dosage forms, the main drugs were injections (53 cases, 49.53%) and powder injections (53 cases, 49.53%); the main organs involved were skin and its appendages (54 cases, 50.47%), followed by the gastrointestinal system (14 cases, 13.08%) and injection sites (10 cases, 9.35%). Conclusion: Anti-infective drug related ADRs mostly occur in the middle-aged and elderly individuals; the main drug types are quinolones and cephalosporins, and the dosage forms are basically injection preparations. Therefore, it is required to strengthen the relevant clinical monitoring to ensure the safe medication for patients.
  • Analysis of Clinical Characteristics of Adverse Drug Reactions Reported in a Three-A General Hospital from 2020 to 2022
    XU Shi-yu, QING Shuang
    2024, 21(10): 1009-1012. https://doi.org/10.13493/j.issn.1672-7878.2024.10-006
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    Objective: To analyze the clinical characteristics of adverse drug reactions (ADRs) reported in the hospital from 2020 to 2022, and provide reference for the clinical safe medication for patients. Methods: The ADR reports of 1 971 cases reported to China National Center for ADR Monitoring by the First Affiliated Hospital of Soochow University from January 2020 to December 2022 were selected as research data. The information such as patient age, clinical manifestations of ADRs and involved organs, as well as types, dosage forms, and administration methods of drugs involved in ADRs was collected to analyze the clinical characteristics of ADRs. Results: In the ADR reports of 1 971 cases, the age of patients was mainly 40 years old or above (1 643 cases, 83.36%). In the three years, the dosage form of drugs involved in ADRs was mainly injection, followed by tablets; the main route of administration was intravenous drip, followed by oral administration; the top 10 drugs involved in ADRs were mainly iodixanol injections, warfarin sodium tablets and anti-tumor drugs, and the reported number of ADRs induced by anti-tumor drugs showed an increasing trend year by year. Among the ADR reports of 1 971 cases, the report type was mainly "general" (1 442 cases, 73.16%), but the reports of "serious" type involved 529 cases (26.84%); the involved organs and systems of serious ADRs (529 cases) mainly included the immune system (136 cases, 25.71%), digestive system (113 cases, 21.36%), skin and its appendages (93 cases, 18.58%) and circulatory system (93 cases, 18.58%). The main consequences of serious ADRs included "leading to hospitalization or prolonged hospitalization" (268 cases, 50.66%) and "leading to other important medical events" (223 cases, 42.16%), but there were 35 cases (6.62%) that endangered patients' lives. Conclusion: The middle-aged and elderly individuals are the high-risk group for ADRs, and the incidence of serious ADRs is relatively high. Therefore, it is required to continuously strengthen the medication education and monitoring in clinical practice to ensure that patients can be treated as soon as possible once ADRs occur and guarantee their safe medication.
  • Analysis of Off-label Use of Doxycycline in Pediatric Outpatient and Emergency Departments of a Hospital*1
    LAO Chu-yu, WANG Yu-qi, CHEN Jie
    2024, 21(10): 1013-1017. https://doi.org/10.13493/j.issn.1672-7878.2024.10-007
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    Objective: To analyze the off-label use of doxycycline in pediatric outpatient and emergency departments of a hospital, and provide reference for the clinical safe use of doxycycline in children. Methods: 68 660 prescriptions from pediatric outpatient and emergency departments of the First Affiliated Hospital of Sun Yat-sen University from November 2023 to June 2024 were selected as research data. The information on the prescriptions such as patient age, gender, clinical diagnosis, medication and laboratory test results was collected to analyze the characteristics and rationality of off-label use of doxycycline. Results: Among 68 660 prescriptions from pediatric outpatient and emergency departments, there were 605 prescriptions (0.88%) that contained doxycycline. Among 605 prescriptions containing doxycycline, the clinical diagnosis of involved children included upper respiratory tract infection (373 prescriptions, 61.65%) and lower respiratory tract infection (232 prescriptions, 38.35%). There were 287 prescriptions (47.44%) for off-label use, of which the main type was "use of drugs beyond the suitable groups" (189 prescriptions, 65.85%), followed by "use of drugs beyond the indications" (99 prescriptions, 34.49%). Among 287 prescriptions for off-label use, 195 prescriptions contained drug combination, of which the most common was combined use with anti-cold drugs (145 prescriptions, 50.52%), and there were 11 prescriptions for combined use with antiviral drugs and 12 prescriptions for combined use with other antibacterial drugs. Among the children involved in 605 prescriptions for doxycycline, 533 cases were tested for Mycoplasma pneumoniae, with a positive detection rate of 86.12%, while the positive detection rates of children with off-label use and those who used drugs beyond the suitable groups were 75.21% and 93.82% respectively. There were 297 cases who received testing for Mycoplasma pneumoniae resistance genes, with a positive detection rate of 86.53%, while the positive detection rates of children with off-label use and those who used drugs beyond the suitable groups were 83.46% and 92.92% respectively. In addition, 395 children (65.29%) had taken macrolides within 7 days before using doxycycline, while 157 children (83.07%) had taken macrolides within 7 days among those who used doxycycline beyond the suitable groups. The evidence-based analysis results showed that 266 prescriptions (92.68%) had evidence-based medicine support among 287 prescriptions for off-label use of doxycycline. Conclusion: There are many cases of off-label use of doxycycline in pediatric department, especially more cases with use of drugs beyond the suitable groups. Although only a few cases are not supported by evidence-based medicine, the relevant clinical training on off-label use should be strengthened to ensure the safe medication for children.
  • Analysis of Correlation between Detection Rate of Methicillin-resistant Staphylococcus Aureus and Antibiotics Use Density in Inpatient Wards of a Hospital from 2012 to 2021*1
    WANG Guang-zhao, MO Jian, LI Yang, MENG Guang-yi, FENG Yin-yi, FENG Zi-wei, LIANG Qiao-lin, HUANG Xing-zhen
    2024, 21(10): 1018-1024. https://doi.org/10.13493/j.issn.1672-7878.2024.10-008
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    Objective: To analyze the correlation between the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and the antibiotics use density (AUD) in inpatient wards of a hospital from 2012 to 2021, and provide reference for the prevention and control of antimicrobial resistance and the rational use of antibacterial drugs. Methods: The etiological results and antibacterial drug use data of specimens sent from inpatient wards of Yulin First People's Hospital from January 2012 to December 2021 were selected as research data. The detection data of Gram-positive bacteria and Staphylococcus aureus (SA) and the resistance rates of SA to various antibacterial drugs were statistically analyzed, the AUD of each antibacterial drug over the years was calculated, and the correlation between the detection rate of MRSA and the AUD was analyzed. Results: From 2012 to 2021, the detection rates of SA in Gram-positive bacteria in inpatient wards of the hospital increased from 26.70% to 50.70%, with a significant change (P<0.01); the detection rates of MRSA in SA fluctuated between 38.20% and 57.04%, with an average detection rate of 48.27%. The drug susceptibility test results showed that the resistance rates of SA against ciprofloxacin, compound sulfamethoxazole, erythromycin, clindamycin, tetracycline, and gentamicin decreased year by year, with significant changes (P<0.01). In addition, the resistance rates of SA against vancomycin and linezolid were always 0.00%. From 2012 to 2021, the AUDs of penicillin, cefazolin, erythromycin, clindamycin, levofloxacin and total quinolones showed a decreasing trend (P<0.05), while the AUDs of ampicillin-sulbactam sodium, piperacillin-tazobactam sodium, vancomycin, linezolid, tigecycline and moxifloxacin showed an increasing trend (P<0.05). The correlation analysis showed that the detection rate of MRSA was positively correlated with the AUDs of penicillin, cefuroxime, erythromycin, azithromycin, levofloxacin and total quinolones (P<0.05) and negatively correlated with the AUDs of ampicillin-sulbactam sodium, ciprofloxacin, vancomycin, linezolid and tigecycline (P<0.05). The linear regression analysis results showed that the coefficient of determination R2 of the correlation between the detection rate of MRSA and the AUDs of azithromycin, levofloxacin, ciprofloxacin and total quinolones was greater than 0.7, which was clinically significant. Conclusion: The detection rates of MRSA in the hospital maintain at a high level all year round and are closely related to the use of azithromycin, levofloxacin, ciprofloxacin and total quinolones. Therefore, the use habits of such highly correlated drugs should be adjusted appropriately during clinical anti-infection treatment to reduce the occurrence of MRSA.