KANGGANRAN YAOXUE

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  • 2021 Volume 18 Issue 7
    Published: 25 July 2021
      
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  • Research Progress in Clinical Prevention and Treatment of Antibacterial Drug-related Hearing Impairment
    WANG Yi-lei, SHEN Jian-fei, SHENG Yi-liang, WU Yan, YANG Zhong
    2021, 18(7): 931-935. https://doi.org/10.13493/j.issn.1672-7878.2021.07-001
    Abstract ( ) Download PDF ( )   Knowledge map   Save
    As a class of drugs that can inhibit the growth of bacteria or cause bacterial death, antibacterials play an important role in the prevention and treatment of infectious diseases, and adverse reactions of antibacterials are the important factors that limit the administration of antibactertials. Studies have shown that many types of antibacterials can cause hearing loss, some of which the symptoms are easy to be overlooked in the early period of medical treatment, and that makes the treatment of hearing loss more difficult. In this paper, the literatures on clinical prevention and treatment of common antibacterial drug-related hearing loss were reviewed and its research progress was analyzed.
  • Research Progress on Clinical Pharmacologic Effects of Matrine and Oxymatrine in Prevention and Treatmet of Bacterial Vaginitis
    ZHANG Ming-fa, SHEN Ya-qin
    2021, 18(7): 936-941. https://doi.org/10.13493/j.issn.1672-7878.2021.07-002
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    Matrine and oxymatrine have a widespread bioactivities, including protection of organs (heart, liver, lung, kidney, brain and blood vessel), positive inotropic action, negative chronotropic action, antiarrhythmia, the effect of increasing leukocyte, antiasthma, antiulcer, anti-fibrogenesis, the central nervous pharmacological action (sedation, hypnogenesis and analgesia), antitumor, immunoregulation, anti-bacteria, anti-virus, anti-parasite and anti-inflammation. In gynecologic domain, matrine and oxymatrine have the effects of anti-gynecologic tumors, and could protect epithelial cells of mamma, endometrium and vagina, and antagonize inflammatory pathologic change of epithelial cells induced by various pathogenic factors. In clinic matrine and oxymatrine have been used to treat various cervicitis and vaginitis,and have been tried to treat mammary cancer, ovarian carcinoma, cervical carcinoma and endometrial carcinoma. In this paper, the literatures on the clinical pharmacological effects of matrine and oxymatrine on the prevention and treatment of bacterial vaginitis have been reviewed, and their research progress has been analyzed.
  • Analysis on Combination and Potential Drug Interactions of Out-patient Prescriptions Containing Clopidogrel in a Hospital
    ZOU Yin, ZHANG Gui-fen, WANG Jian
    2021, 18(7): 941-948. https://doi.org/10.13493/j.issn.1672-7878.2021.07-003
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    Objective: To analyze the medication of clopidogrel in outpatient prescriptions in a hospital and to provide references for clinical safety and rational drug use. Methods: A total of 1 867 out-patient prescriptions containing clopidogrel were collected in a hospital from September to November 2020. Potential drug interactions with clopidogrel were analyzed based on pharmacokinetic and pharmacodynamics principles. Results: Among the 1 867 prescriptions, the male-female ratio of clopidogrel prescription was 1.36:1, employee health insurance accounted for 88.89%, the number of prescriptions was (3.49±1.19) kinds, and "50 mg-q24h-po" drug regimen accounted for 66.67%. The TOP 3 departments of clopidogrel prescription were general medicine, cardiovascular medicine and neurology, and patients with cardiovascular and cerebrovascular diseases were the main drug targets. The drugs contained in the prescriptions (statins accounting for 56.40%, dihydropyridine calcium antagonists accounting for 19.82%, anticoagulants accounting for 10.07%, antiplatelet drugs accounting for 8.78%, proton pump inhibitors accounting for 3.80%, antidepressant drugs accounting for 3.37%, amiodarone accounting for 0.70%, Chinese patent medicine accounting for 14.30%) there are potential interactions. Conclusion: In the elderly patients using clopidogrel in a hospital, the phenomenon of multi-drug combination is common in prescription drugs, and potential drug interactions exist in some patients' prescription drugs, which should be paid great attention to clinically. Pharmacists should improve the level of prescription examination and focus on the potential adverse drug interactions.
  • Analysis on Characteristics and Drug Sensitivity Test Results of 1 225 Cases of Strepto-coccus Agalactiae Infection in Genital Tract of Non-pregnant Women of a Hospital
    WANG Rong-xia
    2021, 18(7): 949-952. https://doi.org/10.13493/j.issn.1672-7878.2021.07-004
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    Objective: To analyze the characteristics of Streptococcus Agalactiae infection (SAI) in genital tract of non-pregnant women and its resistance to antibacterial agents. Methods: Medical records of 1 225 non-pregnant female patients treated in our hospital from September 2013 to September 2019 were selected. The results of SAI culture and drug sensitivity test in the genital tract of patients were analyzed,and the occurrence and distribution of SAI in the genital tract of non-pregnant women in different age groups were analyzed,and the characteristics of SAI in the genital tract of non-pregnant women in different age groups and the characteristics of antibacterial drug resistance were compared. Results: In 1 225 samples from non-pregnant female patients,67 cases (5.47%) were detected as SAI positive in reproductive tract. The incidence of SAI was the highest in urology,followed by gynecology and pediatrics. The detection rate of Streptococcus agalactiae in 31-40 years old non-pregnant women was the highest,followed by 21-30 years old and 41-50 years old. 67 strains of Streptococcus agalactiae were isolated from the samples of 67 positive genital tract SAI patients. The drug resistance rates of Streptococcus agalactiae to tetracycline,clindamycin and erythromycin were all higher than 95.00%,while the drug resistance rates of Streptococcus agalactiae to cefotaxime and penicillin G were all lower than 2.00%. The sensitivity rate of vancomycin to patients without SAI was 100.00%. Conclusion: The incidences of SAI in the genital tract of non-pregnant women are high,especially in the 31-40 years old non-pregnant female patients attending the urology department. Therefore, antibacterial drugs had to rationally selected for treatment based on the results of drug sensitivity test to prevent the generation of drug-resistant strains.
  • Analysis on Pathogen Distribution and Drug Resistance in 50 Patients with Fungal Bloodstream Infection
    SU Jian-wei, ZHOU Mou-qing, HUANG Guo-bin, WANG Yan-hong
    2021, 18(7): 953-957. https://doi.org/10.13493/j.issn.1672-7878.2021.07-005
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    Objective: To analyze the risk factors of nosocomial fungal bloodstream infection, the distribution of pathogenic bacteria and the characteristics of drug sensitivity. Methods: The medical records of 50 patients diagnosed with fungal bloodstream infection in hospital from January 2015 to December 2019 were selected, and the risk factors of fungal bloodstream infection, the distribution of pathogenic bacteria and the influence of drug sensitivity test results on drug use were statistically analyzed. Results: In 50 cases of fungal bloodstream infection, 50 strains of fungi were detected. In them, there were 16 strains of Candida albicans (32.00%), 15 strains of Candida tropicalis (30.00%), 6 strains of Candida smoothing (12.00%), 6 strains of Candida near-smoothing (12.00%), 1 strain of Candida Portugal (2.00%) and 3 strains of Candida namocii (6.00%), 2 strains of Cryptococcus neoformans (4.00%) and 1 strain of Cryptococcus lorente (2.00%). All Candida were sensitive to amphotericin B and voriconazole, Candida smooth was resistant to fluconazole and itraconazole, and Cryptococcus neoformans were resistant to voriconazole and itraconazole.In the elderly population, the proportion of fungal bloodstream infections with cardiovascular disease and pulmonary disease was higher.The incidence of cerebrovascular diseases and other non-basic diseases was higher in young people and below age group. The incidences of fungal bloodstream infection were correlated with the elderly patients with basic diseases easily causing immunodeficiency, the use of greater than for 1 week with ≥2 kinds of broad-spectrum antibacterials, indwelling venous catheter and greater than 2 kinds of risk factors. The rates of antifungal bloodstream infection were 53.45% and 41.38% respectively for caspofungin and fluconazole. Conclusion: The fungal bloodstream infection was mainly Candida albicans, but the proportion of non-Candida albicans increased significantly. Fungemia is associated with basic diseases such as heart and lung in the elderly, while cerebrovascular diseases and other non-basic diseases were more common in the young and below age groups. Therefore, clinical attention had to be paid to fungemia.
  • Analysis on Correlation between Drug Resistance of Klebsiella Pneumoniae and the Defined Daily Dose of Anti-bacterial Agents
    ZOU Ya-li
    2021, 18(7): 957-961. https://doi.org/10.13493/j.issn.1672-7878.2021.07-006
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    Objective: To explore the trend of drug resistance of Klebsiella pneumoniae in hospital, and to analyze its correlation with defined daily dose system (DDDs) of commonly used antibacterials, so as to provide theoretical basis for rational usage of antibacterials in clinical practice. Methods: Data of inpatients using commom antibacterial drugs from 2018 to 2020 were collected to Statistics DDDs value and observe the changing trends of the drug resistance rate of Klebsiella pneumoniae. The correlation between anti-gram-negative drugs and drug resistance of Klebsiella pneumoniae were analyzed by Pearson correlation analysis method. Results: The drug frequency of levofloxacin, piperacillin-tazobactam and biapenem in hospital patients infected with Klebsiella pneumoniae from 2018 to 2020 was positively correlated with the drug resistance rate of Klebsiella pneumoniae to related antibacterial agents. Conclusion: A certain correlation between the frequency of antibacterials usage and the drug resistance of Klebsiella pneumoniae exists, so hospitals should strengthen the clinical usage management of antibacterials to delay the change of bacterial drug resistance, so as to ensure the therapeutic efficacy.
  • Analysis on Clinical Treatment of Patients with Severe Infectious Diseases Participated by Clinical Pharmacists Based on Metagenomic Sequencing Technology*1
    ZHANG Jian-dong, HAN Jing-jing, WANG Hong-yu
    2021, 18(7): 962-965. https://doi.org/10.13493/j.issn.1672-7878.2021.07-007
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    Objective: To analyze the guiding effect of clinical pharmacists on clinical drug therapy of patients with severe infectious diseases assisted by metagenomic next-generation sequencing(mNGS) technique. Methods: The medical records of 3 patients with severe infectious diseases (2 cases of intracranial abscess and 1 case of severe pneumonia after kidney transplantation) in the hospital were selected. In the case that the routine etiological culture and test report was limited, the clinical pharmacist was recommended to adopt metagenomic sequencing technique after consultation. mNGS to identify the pathogen of infection and analyze the pharmaceutical care process of anti-infection medication. Results: Metagenomic sequencing and application identified the infection of pathogenic bacteria in the intraoperative pus samples of 2 patients with brain abscess and in the alveolar lavage fluid samples of 1 patient with severe pneumonia after kidney transplantation. The clinical pharmacists combined with clinical characteristics and pharmaceutical knowledge, put forward individualized pharmaceutical suggestions, and the 3 infected patients were effectively treated. Conclusion: The application of metagenomic sequencing technique provides new technical support for complex infectious diseases and provides more evidence for clinical pharmacist consultation.
  • Analysis on Medication Comment and Unreasonable Reasons of 28 080 Prescriptions of Out-patient and Emergency in a Hospital and Their Countermeasures
    TANG Chen, ZHANG Gui-fen, WANG Jian, WEI Ju-hong, ZHU Ai-guo
    2021, 18(7): 966-972. https://doi.org/10.13493/j.issn.1672-7878.2021.07-008
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    Objective: To analyze the causes of unreasonable reasons drug usage in outpatient and emergency departments and their countermeasures, and to provide reference for rational drug usage. Methods: A total of 28 080 prescriptions of outpatient and emergency were selected from the hospital from January to September 2020. According to the drug instructions and relevant regulations, the rationality of drug use was evaluated and analyzed, and management countermeasures were put forward for the causes of unreasonable prescriptions. Results: In 28 080 prescriptions, 1 333 prescriptions were unreasonable, and the rate of irrational prescriptions was 4.75%. Among the unreasonable prescriptions, there were 1 406 cases of unreasonable reasons. There were 261 prescriptions containing antibacterials (19.58%), 379 prescriptions containing Chinese patent medicine (28.43%), and the average number of drugs was (2.83±1.97) kinds. The TOP 5 departments with unreasonable prescriptions were general internal medicine (18.90%), dermatology (9.83%), ophthalmology (8.10%), otolaryngology (7.88%) and gynecology (5.48%). The main types of unreasonable prescriptions were as follows: 413 cases did not specify "clinical diagnosis" or incomplete clinical diagnosis, accounting for 29.37%;206 cases of improper usage and dosage accounted for 14.65%. The proportion of unsuitable indications was 13.66% in 192 cases.151 cases (10.74%) were unsuitable for combined drug usage. The usage and dosage were unclear in 114 cases (8.11%). Physicians did not comply with the management provisions in the "Guiding Principles for Clinical Application of Antibacterials", and 88 cases of antibacterials prescriptions were issued, accounting for 6.26%. Conclusions: The overall quality of hospital prescriptions is good, but the prominent unreasonable problems need to be improved. The regular evaluation on the rationality of prescription medication should be carried out to ensure the safety and effectiveness of medication for patients.
  • Analysis on Surveillance and Distribution in Different Subtypes of Flu Virus in 952 Hospitalized Children with RTI in Xuchang District and Its Prevention Measures
    YANG Liu
    2021, 18(7): 1040-1043. https://doi.org/10.13493/j.issn.1672-7878.2021.07-030
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    Objective: To investigate the surveillance of influenza virus (Flu virus) in hospitalized children with respiratory tract infection (RTI) in Xuchang District, and the distribution of Flu virus in different subtypes and its countermeasures. Methods: The clinical medical records of 952 children with RTI admitted to the hospital from January 2018 to December 2019 were selected to explore the distribution of Flu virus in different subtypes detected by immunofluorescence method, and the positive status of Flu virus infection in children of different age groups was analyzed. Results: Of the 952 children samples, 121 cases (12.71%) were positive for Flu virus, and the positive rate of Flu virus type A (7.46%) was significantly higher than that of Flu virus type B (7.46% vs 5.52%, P<0.05). In 2018, the percentages of A/H1N1, A/H3N2, B/Victoria and B/Yamagata were 25.62%, 2.48%, 11.57% and 7.44%, respectively. In 2019, the A/H1N1, A/H3N2, B/Victoria and B/Yamagata subtypes were 26.45%, 4.13%, 12.40% and 9.92%, respectively, with A/H1N1 subtype being the most common. Among children of different ages, the positive rate of Flu virus in children aged were between 3 and 5 years for 47.93%, followed by children aged were between 1 and 3 years (22.49%), children aged were between 5 and 12 years (19.01%), and children equal to or less than 1 year was 11.57%. Conclusion: Flu virus was the main pathogenic factor in hospitalized children with RTI in Xuchang District, and the A/H1N1 subtype was the most common, and it mainly occurred between in children aged 3 and 5 years. The general rules of prevention and treatment of infectious diseases should be followed during Flu epidemics. Prevention was more important than treatment.
  • Analysis on Epidemiological Characteristic of 300 Cases with Brucellosis in Yuzhou from 2015 to 2019 and Its Prevention Countermeasures
    SHI Hong-li, YOU Rui-ling
    2021, 18(7): 1043-1046. https://doi.org/10.13493/j.issn.1672-7878.2021.07-031
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    Objective: To analyze the epidemiological characteristics of Brucellosis in Yuzhou and its prevention strategies, and to provide the basis for the formulation of prevention and control measures of Brucellosis. Methods: The data of 300 patients with brucellosis admitted and reported in Yuzhou Center for Disease Control and Prevention from 2015 to 2019 were collected, and the epidemiological characteristics and prevention measures were analyzed by descriptive epidemiological methods. Results: In the 300 cases of brucellosis reported, the ratio of male-female incidence was 2.70∶1.00. 71.67% of the cases were in the age group of 40 to 70 years old, and 91.00% were farmers. Spring and summer are the season of high incidence. Conclusion: The relevant departments of Yuzhou city should take measures in joint prevention and control, do a good job in the prevention and control and elimination of Brucellosis infection sources, the training of grassroots doctors should be increased, do a good job in health education, labor protection and active monitoring of high-risk occupational groups of brucellosis, to curb the spread of the epidemic momentum.
  • Pharmaceutical Care for Anti-infective Medication in a Neonatal Patient of Sepsis with Suppurative Meningitis
    GONG Fu-yong, HE Da-fang, WANG Yan-hong, CHEN Qian-mei, FU Yan
    2021, 18(7): 1047-1049. https://doi.org/10.13493/j.issn.1672-7878.2021.07-032
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    Objective: To explore the pharmaceutical care process of clinical pharmacists participating in the anti-infective medication in neonatal sepsis with suppurative meningitis. Methods: Clinical pharmacists participated in the case analysis of anti-infection medication of a newborn patient with sepsis accompanied by suppurative meningitis, formulation of medication regimen, and implementation of pharmaceutical care throughout the whole process. Results: Through the practice of pharmaceutical care, clinical pharmacists assisted physicians to adjust and optimize the medication treatment plan, which received unanimous clinical praise. The patient was recovered after treatment and was discharged from hospital. Conclusion: Clinical pharmacists actively participated in a clinical drug therapy, strengthened the communication with physicians, played the role of pharmacists in the treatment team, and effectively improved the safety and effectiveness of drug therapy.
  • Evaluation on Application and Efficiency of High-speed Drug Delivery System in Out-patient Pharmacy on Automation Dispensing in a hospital
    PAN Zhen-feng, GU Guo-guang, CHEN Rong, TANG Jie, QIN Qiong, GU Bao-chen, ZHU Jian-guo
    2021, 18(7): 1055-1059. https://doi.org/10.13493/j.issn.1672-7878.2021.07-035
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    Objective: To evaluate the application and working efficiency of High-speed Drug Delivery System (HDDS) in automatic dispensing of outpatient pharmacy, so as to shorten the waiting time of patients. Methods: Research on HDDS and fast-speed drug delivery system (FDDS) in author's hospital, compared with HDDS and FDDS automatic deployment process. The work efficiency and patient waiting time within 90 working days were calculated. The pharmacist satisfaction of two kinds of dispensing mode were estimated by "Five-scale method". Results: The results showed that the waiting time of patients was shortened 80.34% to 89.59% compared with the rapid dispense system. The satisfaction degree of pharmacists to dispensing mode increased between 33.82% and 48.13%. The efficiency of the HDDS increased 23.56% to 41.21% during peak dispensing time. Conclusion: On the whole, the working process of HDDS has been significantly simplified, saving work cost. In view of the fact that the hospital pharmacy is in the stage of automatic upgrading and transformation, the rapid dispensing system, combined with the working mode of HDDS, is conducive to improve work efficiency, shorten the waiting time of patients, and improve the quality of pharmaceutical care.
  • Analysis on Quality Management of TCM Decoction Pieces in 41 Tertiary TCM Medical Institutions in Jiangsu and Their Improvement Measures
    PANG Hui-ming, REN Juan, YAO Yi
    2021, 18(7): 1060-1063. https://doi.org/10.13493/j.issn.1672-7878.2021.07-036
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    Objective: To analyze the quality management status of TCM decoction pieces (TCMDP) in tertiary TCM medical institutions, so as to provide reference for the clinical use of TCMDP. Methods: The TCMDP procurement data of 41 tertiary TCM medical institutions in Jiangsu Province from January to December 2019 were selected. The field inspection method was adopted. Based on the quality standards of Jiangsu Administration of Traditional Chinese Medicine and Jiangsu TCM Quality Control Center, the survey table was developed. The procurement situation of TCMDP in 41 tertiary TCM medical institutions (organization management, procurement mode, supplier, origin and base source) were analyzed, and the improvement measures were put forward. Results: In the 41 tertiary TCM medical institutions, TCMDP procurement system and process were relatively perfect. The TCMDP procurement was mainly in the form of public bidding (36.59%), were 4 to 6 medical institutions as suppliers accounting for 48.78%, and medical institutions were 400 to 600 varieties accounting for 82.93%. 78.05% of the medical institutions had no requirement on TCMDP origin and base source. Conclusions: The quality management team of TCMDP should be improved, its functions and responsibilities should be perfected, and the supply ratio of TCMDP and genuine medicinal materials should be increased in order to ensure the clinical demand and clinical drug safety of TCMDP.
  • Exploration on Quality Control Management and Measures for Precise Dosage Dispensing of Non-whole Injection Drugs in PIVAS of a Children's Hospital
    TANG Ying-jun, ZHOU Li-fang, WANG Feng-jiao
    2021, 18(7): 1063-1067. https://doi.org/10.13493/j.issn.1672-7878.2021.07-037
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    Objective: To analyze the quality control methods and measures for precise dosage dispensing of non-whole injection drugs in pharmacy intravenous admixture services (PIVAS) of children's hospital, so as to provide safe and precise intravenous infusion for clinical departments and to ensure the safety of children infusion. Methods: Data on the usage of 166 kinds of commonly used injectable drugs in PIVAS from August to December, 2020, were collected to analyze the rationality of precise dose allocation of commonly used injectable drugs (dosage form, specifications, dilution requirements, solubility, etc.) in non-whole injection and medication for children. Results: In 166 commonly used injections, the precise dosage of non-whole injection drugs (non-whole solution injection, non-whole aseptic powder for injection, non-whole bag of large infusion drugs) should meet the requirements of rationality of children's medication, and relevant regulations should be formed to ensure the dosage. Conclusion: By establishing the quality control standard for non-whole injection drugs, formulating the "dispensing rules" and standardizing the operation, the precision of the dispensing of finished products by PIVAS can be improved, so as to ensure the safety and rationality of drug usage in children.
  • Influence of Expression of IL-8 and SB7-H3 in Lavage Fluid on Therapeutic Efficacy of Azithromycin in 226 Children with Mycoplasma Pneumoniae Pneumonia*1
    SUN Jin
    2021, 18(7): 1068-1072. https://doi.org/10.13493/j.issn.1672-7878.2021.07-038
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    Objective: To evaluate the expression of IL-8 and sB7-H3 in lavage fluid on the therapeutic efficacy of azithromycin (AZM) in children with Mycoplasma pneumoniae pneumonia (MPP). Methods: Medical records of 226 MPP children treated with AZM in author's hospital from June 2018 to June 2020 were selected and divided into effective group (n=206) and uneffective group (n=20). The clinical efficacy after receiving AZM treatment for 2 weeks and the expression levels of IL-8 and SB7-H3 in the lavage fluid before treatment were counted to evaluate the predictive value of the levels of IL-8 and SB7-H3 in the lavage fluid before treatment for AZM treatment in MPP children. Results: After treatment with AZM for 2 weeks, the levels of IL-8 and SB7-H3 in lavage fluid of 226 MPP children were significantly different between the two groups before treatment (P<0.05). Logistic regression analysis showed that the overexpression of IL-8 and SB7-H3 in lavage fluid of MPP children before treatment was associated with the failure of AZM treatment (OR>1, P<0.05). ROC curve analysis showed that the AUC of IL-8 and SB7-H3 levels in lavage fluid in MPP children before treatment for the risk of failure to azithromycin was greater than 0.80, which was ideal in predicting value. Conclusion: The expression levels of IL-8 and SB7-H3 in lavage fluid of MPP children before treatment were related to the failure of AZM treatment in children, which might be the risk factors for the failure of AZM treatment in children, which had certain value for the prediction of the failure risk of AZM treatment in children.