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  • Research Progress in Individualized Treatment and Precision Dosing for Drug-Resistant Tuberculosis*1
    CHEN Lin-lin, ZHANG Ya-jing, JIA Xiao-meng, BAO Chong-yang
    2026, 23(5): 433-437. https://doi.org/10.13493/j.issn.1672-7878.2026.05-001
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    Drug-resistant tuberculosis is a key priority and major challenge in tuberculosis prevention and control in China. Conventional fixed-dose regimens often overlook factors including interindividual pharmacokinetic variability, strain-specific drug resistance profiles, and underlying diseases, which readily leads to adverse outcomes: insufficient bactericidal efficacy, acquired drug resistance, disease recurrence, and drug accumulation-induced toxicity. With the popularization of novel anti-tuberculosis agents and the maturation of therapeutic drug monitoring technology, the diagnostic and therapeutic pattern for drug-resistant tuberculosis has gradually shifted from standardized therapy to individualized precision therapy. This paper reviews the advantages and existing limitations of current precision diagnosis and treatment, aiming to provide evidence-based references for optimizing individualized treatment regimens for drug-resistant tuberculosis, improving treatment success rates, and reducing the incidence of adverse drug reactions.
  • Anti-infective Therapy and Pharmaceutical Care for Glucocorticoid Administration in a Patient with Acute Gastroenteritis Complicated by Abdominal Henoch-Schönlein Purpura*1
    GAO Xiao-ning, SONG Wen-lin, LU Ling-hong, JIN Tai-wei, SUN Lin, WANG Yan-yan, DU Xiao-chen, ZHANG Xue-nong, PEI Na, ZHOU Yu
    2026, 23(5): 438-443. https://doi.org/10.13493/j.issn.1672-7878.2026.05-002
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    Objective: To analyze the anti-infective therapy and pharmaceutical care process of glucocorticoid administration in a patient with acute gastroenteritis complicated by abdominal Henoch-Schönlein purpura (HSP), so as to provide a reference for clinical diagnosis and treatment of abdominal HSP. Methodsand Results: A 9-year-and-7-month-old boy was admitted due to "acute gastroenteritis". After admission, the abdominal pain progressively worsened, accompanied by hematochezia and intestinal wall edema. Initial empiric treatment included latamoxef for anti-infection, famotidine for acid suppression and gastric protection, combined with fluid resuscitation support, yet the patient's symptoms failed to alleviate. The anti-infective scheme was then adjusted to cefoperazone-sulbactam sodium, while omeprazole replaced famotidine for acid suppression. On the third day after admission, gastroscopy and colonoscopy revealed gastroduodenal ulcer and ileal ulcer with bleeding, suggestive of HSP. Clinical pharmacists recommended adding loratadine for antiallergic treatment. On the eighth day after admission, characteristic rashes appeared on bilateral lower extremities, confirming the diagnosis of abdominal HSP. Oral prednisone was prescribed together with calcium carbonate to prevent glucocorticoid-induced osteoporosis. Two days later, rashes recurred after meals. After evaluation, clinical pharmacists recommended discontinuing oral prednisone and replacing with methylprednisolone pulse therapy, and famotidine was reused for gastric protection. As infection markers declined, cefoperazone-sulbactam was discontinued and switched to oral cefdinir as sequential therapy. Subsequent glucocorticoid dosage was adjusted dynamically based on laboratory results. During hospitalization, the patient developed HSP-related epididymitis, which resolved after symptomatic treatment. After treatment, the patient's symptoms improved significantly, and he was discharged with maintenance sequential prednisone therapy. One week post-discharge follow-up showed no new rashes or abdominal pain, and all indicators returned to normal. Conclusion: During treatment of abdominal HSP, clinical pharmacists implement full-course pharmaceutical care and medication education by participating in optimization of anti-infective schemes, adjustment of glucocorticoid doses and monitoring of adverse drug reactions, which can improve the safety and efficacy of treatment and enhance the prognosis of pediatric patients.
  • Anti-infective Therapy and Pharmaceutical Care in a Patient with Hemophagocytic Syndrome Secondary to Visceral Leishmaniasis
    GAO Ting, WU Yan, MA Li, XIONG Shi-juan
    2026, 23(5): 444-448. https://doi.org/10.13493/j.issn.1672-7878.2026.05-003
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    Objective: To analyze the diagnosis and treatment course of a patient with visceral leishmaniasis (kala-azar) complicated by hemophagocytic syndrome presenting with fever, pancytopenia and splenomegaly, and to explore anti-infective treatment strategies and key points of pharmaceutical care when first-line agents are unavailable, so as to provide a reference for clinical diagnosis and treatment of this disease. Methodsand Results: A 23-year-old male patient was hospitalized due to persistent hyperpyrexia, splenomegaly and pancytopenia. Bone marrow smears revealed hemophagocytosis and Leishman-Donovan bodies. Metagenomic next-generation sequencing of peripheral blood and bone marrow both detected the Leishmania donovani species complex, establishing the diagnosis of hemophagocytic syndrome secondary to visceral leishmaniasis. Since sodium stibogluconate (pentavalent antimonial) was initially unavailable, liposomal amphotericin B was administered as an alternative anti-leishmanial agent. After pentavalent antimonial was allocated and delivered, the therapeutic regimen was switched immediately. On the next day after the drug switch, the patient's body temperature returned to normal; C-reactive protein and interleukin-6 levels declined, while platelet count recovered steadily. At the end of the treatment course, repeat bone marrow smears showed no Leishman-Donovan bodies, and the patient was discharged with significant clinical improvement. Conclusion: For patients with acute critical visceral leishmaniasis, liposomal amphotericin B acts as an alternative when pentavalent antimonial is unavailable; timely switch to pentavalent antimonial once available can rapidly relieve clinical symptoms. Successful therapeutic outcomes rely on early definite diagnosis, prompt drug conversion, as well as adequate dosage and complete treatment course. Full-cycle pharmaceutical care by clinical pharmacists, with close monitoring of complete blood count, hepatic and renal function, and ECG, is crucial for medication safety and better prognosis.
  • Adverse Drug Reaction Analysis of a Patient with Drug-induced Liver Injury Caused by Xinyuan Capsules and Traditional Chinese Medicine Decoction
    LI Rui-hua, LU Huan-jun
    2026, 23(5): 449-452. https://doi.org/10.13493/j.issn.1672-7878.2026.05-004
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    Objective: To analyze the adverse drug reaction identification process and underlying causes in a patient with drug-induced liver injury (DILI) caused by Xinyuan Capsules and traditional Chinese medicine (TCM) decoction, so as to provide a reference for safe and rational clinical medication. Methodsand Results: A 29-year-old female patient with poorly controlled hyperthyroidism took modified TCM decoction (Shengmai Yin and Xiaoyao San) for qi-tonifying, yin-nourishing, liver-soothing and spleen-strengthening effects at an external hospital, and concurrently received Xinyuan Capsules for arrhythmia control. After continuous medication for approximately 3 weeks, she was admitted due to "epigastric pain and distension with dark urine for 5 days". Markedly abnormal liver function was detected on admission. Based on clinical manifestations and laboratory findings, Xinyuan Capsules and TCM decoction were immediately discontinued. The patient was treated with magnesium isoglycyrrhizinate for anti-inflammatory and hepatoprotective effects, glutathione for antioxidation, omeprazole for acid suppression and gastric protection, and intermittent metoclopramide for antiemesis. On day 5 of admission, although epigastric pain was relieved, persistent dark urine, pruritic limb rashes and scleral icterus were observed. The glutamyl transpeptidase level continued to rise and the bilirubin level failed to decrease obviously. Ursodeoxycholic acid was added for jaundice, and topical Fule Cream was given for relief of pruritus. After treatment, the patient's symptoms were substantially improved with resolved epigastric pain and normalized urine color. Relevant indicators on reexamination approached normal ranges, and the patient was discharged. Conclusion: Multiple ingredients, including processed Polygoni Multiflori Radix in Xinyuan Capsules, as well as wine-processed Scutellariae Radix, vinegar-processed Schisandrae Chinensis Fructus, Moutan Cortex and Uncariae Ramulus cum Uncis in TCM decoction, possess potential hepatotoxicity. The combined administration of multiple hepatotoxic herbs and off-label dosing are the major causes of DILI in this case. Clinicians and pharmacists should attach importance to the liver injury risks of Chinese herbal medicines, strengthen medication monitoring and rational drug use education.
  • Adverse Drug Reaction Analysis of a Patient with Neutropenia Induced by Piperacillin-Tazobactam Sodium*1
    HUANG Wei-bin, CHEN Pei-shan
    2026, 23(5): 453-455. https://doi.org/10.13493/j.issn.1672-7878.2026.05-005
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    Objective: To analyze the adverse drug reaction identification process in a patient with neutropenia induced by piperacillin-tazobactam sodium, so as to provide a reference for clinical medication safety and adverse drug reaction monitoring. Methodsand Results: A patient was admitted due to "recurrent cough, fever, abdominal distension and nausea for over half a month". Empirical treatment with amoxicillin-clavulanate potassium (1.2 g, q12h, intravenous infusion) was initiated. After 2 days, fever persisted with severe cough and expectoration, so the regimen was switched to piperacillin-tazobactam sodium (4.5 g, q8h, intravenous infusion). On day 16 of medication, clinical pharmacists observed a decline in neutrophil count and conducted a multi-dimensional analysis with the attending physician. On day 18, neutrophil count dropped to 0.61×109/L despite improved clinical symptoms, which was judged as an adverse drug reaction. After reviewing medication orders and temporal correlation, pharmacists recommended discontinuing piperacillin-tazobactam sodium and adding human granulocyte colony-stimulating factor. Three days later, neutrophil count returned to normal. Conclusion: With professional sensitivity, clinical pharmacists completed the overall process from detection, analysis, intervention to adverse drug reaction reporting, enabling timely and effective treatment and smooth discharge of the patient. This case demonstrates the role of clinical pharmacists in the treatment team and in safeguarding medication safety for patients.
  • Adverse Drug Reaction Analysis of Acute Severe Thrombocytopenia Induced by Tirofiban in a Patient with Acute Stroke
    LI Mei-ling
    2026, 23(5): 456-459. https://doi.org/10.13493/j.issn.1672-7878.2026.05-006
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    Objective: To analyze the identification process and occurrence mechanism of severe thrombocytopenia induced by tirofiban in a patient with acute stroke, so as to provide a reference for safe clinical medication. Methodsand Results: A 75-year-old male patient was admitted for acute cerebral infarction with a baseline platelet count of 162×109/L. After alteplase thrombolysis, tirofiban was administered via intravenous pump for antiplatelet aggregation on the next day. Approximately 1 hour after administration, the patient developed sudden chills, high fever and scattered ecchymoses on the left upper extremity. Tirofiban was discontinued immediately, and emergency testing showed that the platelet count dropped sharply to 18×109/L. Symptomatic treatment was given, including diazepam, promethazine and paracetamol. Two units of ABO-identical leukoreduced apheresis platelets were transfused on day 2 after drug discontinuation. One day after transfusion, the platelet count recovered to 233×109/L, and the skin ecchymoses were significantly improved. Conclusion: Tirofiban is a commonly used antiplatelet agent in clinical practice, but it can induce acute severe thrombocytopenia shortly after administration. Close monitoring of platelet count is required during clinical use, especially within the initial hours of treatment. For high-risk elderly patients with multiple underlying diseases, intensified monitoring frequency is essential to ensure medication safety.
  • Effect of Clinical Pharmacist-Led Individualized Pharmaceutical Care on Vancomycin Trough Concentrations and Medication Safety in ICU Patients*1
    FAN Wei-wei, CUI Wei-yan, YANG Yu-ya, LI Jie, ZHU Chun-xiang
    2026, 23(5): 464-470. https://doi.org/10.13493/j.issn.1672-7878.2026.05-008
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    Objective: To analyze the effect of clinical pharmacist-led individualized pharmaceutical care on vancomycin trough concentrations and medication safety in ICU patients, so as to provide a reference for enhancing rational and safe vancomycin administration. Methods: Patients admitted to the ICU of Wujin Hospital Affiliated to Jiangsu University who received vancomycin therapeutic drug monitoring (TDM) from January 2022 to December 2024 were selected as research subjects. All subjects were divided into three stages: the pre-intervention period (2022), the first year after pharmaceutical intervention (2023), and the second year after intervention (2024). The changes in the distribution of first monitored trough concentrations, target attainment rate, supratherapeutic rate, and incidence of acute kidney injury (AKI) of vancomycin were compared. Results: A total of 162 patients were included, including 51 cases before intervention, 49 cases in the first post-intervention year, and 62 cases in the second post-intervention year. The median trough concentration was higher than 20 mg/L before intervention, decreased in the first post-intervention year, with a statistically significant difference in the second year compared with the trough concentration before intervention (P<0.05). Subgroup analysis was performed according to whether patients received continuous renal replacement therapy (CRRT). In the non-CRRT group, the trough concentration decreased continuously after intervention, with a statistically significant difference in the second year compared with the trough concentration before intervention (P<0.05). In the CRRT group, the trough concentration did not decrease obviously in the first year after intervention, but reduced significantly in the second year, with a statistically significant difference compared with the trough concentration before intervention (P<0.05). The overall initial target attainment rate was 31.37% before intervention, the overall target attainment rate increased to 40.81% in the first post-intervention year with no statistically significant difference compared with that before intervention (P<0.05), and it increased to 50.00% in the second year with a statistically significant difference compared with that before intervention (P<0.05). The rate of supratherapeutic trough concentrations was 50.99% before intervention, decreased to 34.70% in the first post-intervention year and continued to decline in the second year, with no statistically significant difference compared with that before intervention (P>0.05). Although the incidence of vancomycin-associated AKI in the non-CRRT group showed a downward trend after intervention, no statistically significant difference was observed in the incidence of AKI before and after intervention (P>0.05). Conclusion: Clinical pharmacist-led individualized pharmaceutical care for vancomycin can improve the initial trough concentration attainment rate, reduce supratherapeutic concentrations, and show a trend toward a decreased risk of AKI in critically ill patients.
  • A Multidimensional Comparative Study of Baloxavir Marboxil and Oseltamivir for Treatment of Influenza
    GE Feng, LONG Sheng-juan
    2026, 23(5): 470-475. https://doi.org/10.13493/j.issn.1672-7878.2026.05-009
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    Influenza is a Category C infectious disease triggered by influenza viruses, mainly influenza A and influenza B viruses. Featuring high infectiousness, high incidence and high variability, widespread influenza outbreaks bring severe public health burdens to society. Baloxavir marboxil and oseltamivir are two representative anti-influenza agents currently used clinically. However, systematic comparative studies on multidimensional differences of the two drugs remain insufficient, which restricts the formulation of accurate individualized treatment strategies in clinical practice. Based on existing relevant studies regarding baloxavir marboxil and oseltamivir, this article summarizes their discrepancies in multiple dimensions, including therapeutic efficacy, mechanism of action, eligible populations, safety and economics, so as to provide a reference for optimizing individualized therapeutic regimens, mitigating influenza transmission and community outbreaks.
  • Discussion and Suggestions on the Chinese Expert Consensus on Ward-Based Pharmacist Work Mode
    TANG Xiao-xia, LI Jin-rong, ZHANG Cong, LIU Jun, ZHANG Hong-xu, GUO Hui
    2026, 23(5): 476-481. https://doi.org/10.13493/j.issn.1672-7878.2026.05-010
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    This paper systematically reviews the Chinese Expert Consensus on Ward-Based Pharmacist Work Mode. Combined with the developmental demands of standardized clinical pharmacy administration in China and frontline practical experience of ward-based pharmacists, discussion and suggestions are put forward from four dimensions, including general principles, work mode, service specifications, quality control and evaluation. Main recommendations are as follows. Revise the term "ward-based pharmacist" to "ward-based clinical pharmacist" to reflect the clinical responsibilities of such staff more precisely. Make full use of artificial intelligence and hospital information systems to boost working efficiency, and establish a written system for clinical pharmaceutical care analysis reporting, so as to realize traceable pharmaceutical recommendations and clear accountability boundaries. Refine key service items covering admission, in-hospital and discharge stages. Strengthen effective communication and personnel qualification requirements during joint medical-pharmacy ward rounds and pharmaceutical consultations. Standardize written records for medication counseling. Define the reasonable scope of service quality control and evaluation, and delete any paid promotion clauses not relevant to the evaluation. The above suggestions are intended to advance the standardization, informatization and institutionalization of ward-based pharmacist work mode, so as to fully guarantee medication safety for patients.
  • Pharmaceutical Practice of Anti-infective Agents with Hepatic Enzyme Inhibitory Effects in Patients on Rivaroxaban Therapy*1
    ZHU Xia-qing
    2026, 23(5): 481-486. https://doi.org/10.13493/j.issn.1672-7878.2026.05-011
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    Objective: To analyze pharmaceutical care strategies for elderly patients with atrial fibrillation receiving rivaroxaban combined with hepatic enzyme-inhibitory anti-infective agents, so as to provide a reference for safe and rational clinical medication. Methodsand Results: Case 1: A 73-year-old female patient suffered from chronic obstructive pulmonary disease complicated with aspergillosis, atrial fibrillation and lower-extremity venous thrombosis, receiving long-term oral rivaroxaban. Voriconazole was scheduled for antifungal treatment. Pharmacists noticed that her body weight was only 36 kg and recommended dose reduction of voriconazole. As a CYP3A4 inhibitor, voriconazole may significantly elevate rivaroxaban plasma concentrations. Therefore, low-molecular-weight heparin was suggested for anticoagulation during therapy, followed by sequential isavuconazole with milder hepatic enzyme inhibition after discharge. The patient's chest tightness and dyspnea were relieved, without bleeding or embolism. Case 2: A 90-year-old female patient complicated with fungal pneumonia, heart failure and atrial fibrillation was administered cefoperazone-sulbactam sodium plus voriconazole (0.2 g, q24h). Pharmacists advised discontinuing unnecessary cefoperazone-sulbactam sodium, and pointed out that voriconazole was prescribed without a loading dose and with an inappropriate dosing frequency. The regimen was then adjusted to a loading dose of "0.3 g, q12h, intravenous infusion", followed by a maintenance dose of "0.2 g, q12h, intravenous infusion". Considering advanced age, worsening renal function and drug interaction, it was advised to reduce the dose of rivaroxaban to "10 mg, q24h". The physician adopted the advice, and the patient was discharged with the prescribed medication after symptom improvement. Case 3: An 80-year-old male patient with COVID-19 and atrial fibrillation received rivaroxaban (10 mg, q24h). Pharmacists pointed out that nirmatrelvir/ritonavir, a CYP3A4 inhibitor, could substantially suppress rivaroxaban metabolism, and recommended switching to deuremidevir hydrobromide with negligible drug interaction. Risk assessment indicated higher thrombotic risk than bleeding risk as well as insufficient anticoagulation intensity. Rivaroxaban was suggested to be uptitrated to "15 mg, q24h" as appropriate after anemia correction. The physician adopted the advice, and the patient was discharged after symptom improvement. Conclusion: Co-administration of rivaroxaban and CYP3A4 inhibitors in elderly patients with atrial fibrillation can significantly strengthen anticoagulant effect and raise bleeding risk. Clinical pharmacists should dynamically evaluate thrombotic and bleeding risks, preferentially select anti-infective agents with a lower risk of drug interaction, adjust anticoagulation regimens or carry out therapeutic drug monitoring if necessary. In-depth involvement of clinical pharmacists can help ensure medication safety for elderly multimorbid patients, and provide individualized decision-making support for complex scenarios involving concurrent anticoagulant and anti-infective therapy.