2020 Volume 22 Issue 1 Published: 28 January 2020
  

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  • Jiang Rongmeng, Song Meihua
    Abstract ( ) PDF ( )
    Special populations, such as infants, pregnant and lactating women, patients with liver and kidney dysfunction, and the elderly, have different degrees of immune dysfunction, whose probability of infection and the utilization rate of antibacterials are higher than those in other populations. The risk of adverse reactions is higher in these special populations because of their special pathophysiological state and characteristics of drug metabolism. Therefore, more attention should be paid to the safety of antibacterials in these populations. To master the pathophysiological characteristics of special populations and the pharmacokinetic characteristics of the antibacterials and strengthen the audit and comment on the prescription of antibacterials in the special populations will help to improve the level of rational use of antibacterials, so as to reduce their damages to special populations.
  • Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs, Chinese Pharmacological Society Professional Committee of Drug-induced Diseases, Adverse Drug Reacti
    Abstract ( ) PDF ( )
    Barcode technology is a kind of automatic recognition technology which is produced and developed in computer application and practice. Barcode technology has been widely used in drug purchase, management, dispensing, use and other aspects, and plays an important role in reducing human errors, improving work efficiency, and reducing medication errors in drug information check, information matching of drug and patient, and other important links. However, barcode technology can also lead to medication errors due to human operation, technical level, and other factors during application. In order to strengthen the prevention of medication errors related to the application of drug barcode technology in medical institutions, experts in pharmaceutical, nursing, informational, and management, who were organized by Medication Safety Panel in China Core Group of International Network for the Rational Use of Drugs, Chinese Pharmacological Society Professional Committee of Drug-induced Diseases, and Adverse Drug Reactions Journal Agency, formulate the guideline for prevention of medication errors in application of barcode technology in medical institutions after several argumentation based on the Expert Consensus on Medication Error Management in China. The medication errors related to drug barcode technology may occurred in links of drug storage and delivery, drug dispensing and distribution, intravenous drug admixture, inpatient drug administration, and etc. The risk factors include systematic factors (damaged barcode quality, poor barcode printing quality, scanning and printing equipment problems, packaging problems, system defects, and sharing difficulties of internal barcode information) and human factors (barcode information maintenance error, not timely information update, wrong pasted barcode, too little internal barcode information, operation error, and improper implementation). The prevention strategies for medication errors related to drug barcode application include technical strategies (including enforcement and constraint policies, automation and information, establishment of good checking system) and management strategies (including regulatory framework, environment and personnel). The guideline is formulated for all medical staff involved in the application and management of drug barcode technology in medical institutions.
  • Tang Wen, Jiang Chunyan, Sun Ying, Zhao Zhen, Ma Qing
    Abstract ( ) PDF ( )
    Objective To explore the short-term prognosis and influencing factors of oral voriconazole in elderly patients with invasive pulmonary fungal infection (IPFI). Methods By searching hospital information system in Beijing Friendship Hospital, Capital Medical University, the medical records of elderly patients (≥80 years) who were diagnosed as IPFI and treated with oral voriconazole in Department of Geriatrics from January 2016 to December 2017 were collected and analyzed retrospectively. The basic information, basic diseases, combined medication, baseline value of liver and kidney function, treatment course of oral voriconazole, and liver and kidney function and survival status within 30 days after medication were recorded. The influencing factors of all-cause liver injury, acute renal injury (AKI), and death within 30 days after oral voriconazole were analyzed by multivariate logistic regression. The odds ratio (OR) and its 95% confidence interval (CI) were calculated. Results A total of 34 patients were entered, including 20 males and 14 females with age of (91±5) years. Of them, 6 patients (17.6%) developed liver injury, 7 patients (20.5%) developed AKI, and 9 patients (26.5%) died within 30 days after treatment with oral voriconazole. Multivariate logistic regression analysis showed that age was an independent risk factor for liver injury within 30 days after treatment with oral voriconazole (OR=1.33, 95%CI: 1.03-1.73, P=0.03), baseline estimated glomerular filtration rate (eGFR)<60-ml/(min·1.73 m2) was an independent risk factor for AKI (OR=13.00, 95%CI: 1.27-133.29, P=0.03), AKI was an independent risk factor for death within 30 days (OR=48.00, 95%CI: 4.21-547.18, P<0.01). Conclusions The risk of liver injury, AKI, and death was higher within 30 days after oral administration of voriconazole in elderly patients with IPFI. Age and baseline eGFR<60-ml/(min·1.73 m2) were independent risk factors for liver injury and AKI, respectively. AKI was an independent risk factor for death.
  • Li Taoming, Zou Le, Hu Lin, Yin Tao
    Abstract ( ) PDF ( )
    Objective To explore the occurrence and clinical characteristics of antibacterial-associated encephalopathy (AAE) in patients with chronic kidney disease (CKD). Methods The electronic medical records of patients with CKD stages 3-5 and treated with antibacterials for more than 2 days during hospitalization in Xiangya Hospital of Central South University from January 1 to December 31, 2016 were collected. The patients who were with neuropsychiatric symptoms or diagnosed as encephalopathy after antibacterials treatments were screened out and scored by clinicians and pharmacists using Naranjo evaluation method. The patients with scores of ≥ 4 were judged as AAE. The AAE patients′ basic information, basic disease information, application of antibacterials, and AAE related information were extracted and analyzed descriptively. Results A total of 977 (40.07%) of 2-438 inpatients with CKD stages 3-5 were treated with antibacterials. Thirty-three patients (3.38%) were judged to have AAE by comprehensive evaluation. Among 33 patients with AAE, 15 patients were male and 18 were female, with age of 68 (56, 78) years (ranging from 27 to 88 years); 2 patients were with CKD stage 3b, 6 patients with stage 4, and 25 patients with stage 5; 21 patients underwent dialysis; their serum creatinine was (492±265) μmol/L, blood urea nitrogen was (16.9±10.7) mmol/L, and estimated glomerular filtration rate (eGFR) was 10.4 (7.0, 14.9) ml/(min·1.73 m2). The antibacterials related to AAE were beta-lactams and fluoroquinolones, of which cefepime had the highest incidence of AAE [28.57%(4/14), 95%CI: 1.5-55.6], followed by ceftazidime [14.67%(11/75), 95%CI: 6.5-22.9]. The time from the use of antibacterials to the occurrence of AAE was (6±3) days. The main clinical manifestations of AAE were delirium and mania (45.45%, 15/33), involuntary movement of limbs and epilepsy (18.18%, 6/33 for both), apathy (15.15%, 5/33), lethargy (12.12%, 4/33), delusion and hallucination (3.03%, 1/33). Thirty-three patients with AAE were treated with discontinuation or replacement of antibacterials, intensive dialysis, hemofiltration, and symptomatic treatments. By the time of discharge, the symptoms in 30 patients (90.9%) disappeared and 3 patients (9.10%) were not cured. Conclusions The patients with CKD were at increased risk for AAE, especially for those treated with beta-lactams. The dosage of antibacterials drugs should be adjusted according to eGFR in CKD patients and monitored during the treatment so as to prevent the occurrence of AAE.
  • Jiang Yongxian, Li Gen, Wang Yulan, Wu Bo, Wang Han, Zhu Ling
    Abstract ( ) PDF ( )
    Objective To explore the occurrence and clinical characteristics of hypersensitivity reactions induced by antimicrobial drugs in neonates. Methods The reports of hypersensitivity reactions induced by antimicrobial drugs in Neonatology Department of Chengdu Women′s and Children′s Central Hospital from January 1, 2015 to December 31, 2017 were collected. According to the basic information of children provided by the reports, the electronic medical records of the children were collected from the hospital information system and the data of application, occurrence, treatments, and outcomes of hypersensitivity reactions were recorded. The clinical manifestations, types, and severity of hypersensitivity reactions were evaluated by 3 pharmacists according to relevant standards. From the hospital information system, the total number of outpatients and inpatients in Department of Neonatology in the same period was counted, the usage of antimicrobial drugs was recorded, and the incidence of hypersensitivity reactions due to antimicrobial agents was caculated. Results A total of 73 reports of hypersensitivity reactions to antimicrobial drugs in Department of Neonatology were entered, involving 73 newborn infants; there were 21-146 infants using antimicrobial agents at the same time, so the incidence of antimicrobial hypersensitivity reactions was 0.35%. Among the 73 children, 34 were male and 39 were female; the ages on visit or admission to the hospital was (14±7) days; 69 (94.52%) were given injections of antimicrobial agents and 4 (5.48%) were given oral preparations. A total of 20 antimicrobial agents of 7 categories were used; the top 3 were cephalosporins (32 infants, 43.84%), penicillins (21 infants, 28.77%), and cephamycins (6 infants s, 8.22%). The top 3 drugs with higher incidence of hypersensitivity reactions were levofloxacin hydrochloride injection (2/4), erythromycin lactobionate for injection [1.29% (4/311)], and vancomycin hydrochloride for injection [1.07% (4/374)]. Among the 73 infants, 4 (5.48%) had immediate hypersensitivity reactions, of which 3 were severe (including 1 with anaphylactic shock, 1 with dyspnea, and 1 with severe anaphylactic reaction) cases; 69 (94.52%) had nonimmediate hypersensitivity reactions, mainly manifested as rash, digestive system symptoms, and fever, of which 6 were severe cases (including 3 infants with hepatobiliary system injury, 2 with neutropenia, and 1 with severe drug eruption). After discontinuation of suspected drugs and/or antiallergic and symptomatic treatments, 71 of 73 newborns recovered (97.26%) and 2 (2.74%) improved. Conclusions The incidence of hypersensitivity reactions induced by antimicrobial drugs in newborns in Chengdu Women′s and Children′s Central Hospital was 0.35%. The clinical types of hypersensitivity reactions induced by antimicrobial drugs in neonates were mainly nonimmediate types, most of them were general hypersensitivity reactions, but the immediate drug hypersensitivity reactions were mostly severe hypersensitivity reactions.
  • Sun Huibin, Zhang Zhong, Liu Zheng, Zhang Huizhi
    Abstract ( ) PDF ( )
    Objective To explore the effect of dose adjustment based on doxofylline blood concentration monitoring on safety of combination of doxofylline and terbutaline for respiratory diseases.  Methods The subjects were selected from patients who received doxofylline injection, terbutaline sulphate solution for nebulizationor, and the combination of the two drugs and hospitalized in Department of Respiratory Medicine of Zhengzhou Second People′s Hospital from January 1, 2014 to December 31, 2018. Patients who met the inclusion criteria were divided into 3 groups: doxofylline group, terbutaline group, and combination of doxofylline and terbutaline group (combination group). All patients in the 3 groups were given conventional treatments and symptomatic treatments. Doxofylline 300-mg once daily was given by an IV infusion and terbutaline 2-ml (5-mg) thrice daily was given by atomized inhalation for 7-14 days. Adverse reactions in the 3 groups were compared. The dosage of doxofylline in patients with adverse reactions of grade 1 was adjusted to 250-mg once daily, 200-mg once daily for patients with adverse reactions of grade 2, and doxofylline was stopped in patients with adverse reactions of more than grade 3. The blood concentration of doxofylline, the proportion of the patients whose adverse reactions were alleviated or disappeared, the length of hospital stay, and the efficiency of treatment before and after dose adjustment of doxofylline in patients in the doxofylline group and the combination group were compared. Results A total of 6-582 patients were entered in the study. Of them, 1-438 patients were in the doxofylline group, including 793 males and 645 females with age of (61±11) years; 2-217 patients were in the terbutaline group, including 1-281 males and 936 females with age of (60±15) years; 2-927 patients were in the combination group, including 1-644 males and 1-283 females with age of (63±12) years. The differences in gender, age distribution, basic disease, combined disease, and combination medication among the 3 groups were not statistically significant (P>0.05). The overall incidences of adverse reactions in the 3 groups were 13.1% (189/1-438), 8.9% (197/2-217), and 21.2% (620/2-927), respectively, which was higher in the combination group than that in the doxofylline group (χ2=41.271, P<0.001) and the terbutaline group (χ2=142.766,P<0.001) and higher in the doxofylline group than that in the terbutaline group (χ2=16.738,P<0.001). The incidences of tremor and headache in the combination group were higher than those in the other 2 groups(P<0.001), the incidence of hyperglycemia was higher than that in the doxofylline group(P=0.003), the incidence of insomnia was higher than that in the terbutaline group(P<0.001), the incidence of tachycardia was higher than that in the terbutaline group(P<0.001), the incidence of nausea was lower than that in the doxofylline group(P<0.001)and higher than that in the terbutaline group(P<0.001), the incidence of mood disorders was higher than that in terbutaline group (P=0.017). No adverse reactions of more than grade 3 occurred in the 3 groups, the difference in proportions of patients with adverse reactions of grade 1 and grade 2 was not statistically significant(χ2=1.097,P=0.578). The difference in blood concentration of doxofylline in patients with adverse reactions between the combination group and the doxofylline group was not statistically significant before dose adjustment (P>0.05), but all decreased after dose adjustment (all P<0.001) and the blood concentration of doxofylline in the combination group was lower than that in the doxofyllin group [(8.38±2.19) μg/ml) vs. (10.64±2.55) μg/ml, P<0.001]; the proportion of patients whose adverse reactions were alleviated or disappeared in the combination group was higher than that in the doxofylline group [40.81% (253/620) vs. 30.16% (57/189), P=0.008], the hospitalization time was shorter than that in the doxofylline group [(10±2) d vs. (15±3) d, P<0.001], the treatment efficiency was higher than that in the doxofylline group [531 (85.65%) vs. 136 (71.96%), P<0.001]. Conclusion When doxofylline injection is combined with terbutaline solution for nebulizationor, the blood concentration of doxofylline can be controlled at (8.38±2.19) μg/ml by monitoring the blood concentration of doxofylline, which can not only improve the treatment efficacy, but also improve the medication safety.
  • Zhang Shaonan, Huang xiaohui, Yue Huijie
    Abstract ( ) PDF ( )
    Polymyxin B is mainly used in the treatment of severe drug-resistant gram-negative bacterial infection. In recent years, more and more cases of skin pigmentation caused by polymyxin B have been reported. The incidence of polymyxin B-related skin pigmentation in infants was higher than that in adults. The mechanism of polymyxin B-induced hyperpigmentation is not clear, which may be related to histamine release, skin inflammation, and the stimulation of melanin synthesis induced by polymyxin B. Although skin pigmentation has no significant effect on the treatment and prognosis in patients, it may cause psychological burden and affect the life quality, which should be paid more attention to and further studied.
  • Zhou Anqin, Luo Min, Zhang Dengliang, Xu Ting
    Abstract ( ) PDF ( )
    A 75-year-old male received an IV infusion of moxifloxacin hydrochloride injection (moxifloxacin) 400-mg/d once daily for valvular heart disease complicated with heart failure and pulmonary infection. On the second day, the electrocardiogram showed that the corrected QT interval (QTc) was prolonged from 455-ms before treatment to 490-ms. On the third day, amiodarone hydrochloride for injection (amiodarone) 150-mg was given by slow intravenous injection in the early morning due to atrial fibrillation and 300-mg of amiodarone was continuously pumped at the speed of 30-mg/h at noon. In the afternoon of the 4th day, amiodarone 300-mg was given again via a pump at a speed of 30-mg/h. About 20-minutes later,the QTc was prolonged to 607-ms. On the 5th day, amiodarone was not given again, but the QTc continued to be prolonged up to 674-ms. On the 6th day, the QTc gradually returned to be within the normal range after discontinuation of moxifloxacin. The prolongation of QT interval in the patient was considered to be associated with moxifloxacin and amiodarone.
  • Gao Lingyan, Wang Yue, Liu Yuling, Deng Ang
    Abstract ( ) PDF ( )
    A 53-year-old female patient received oral ethambutol, pyrazinamide, isoniazid, and moxifloxacin, as well as intramuscular injection of capreomycin for drug-resistant tuberculosis. After 11 months of treatments, the patient developed nausea, vomiting, fatigue, weakness of limbs, gradually aggravating with soft paralysis of both legs. Laboratory tests showed the lowest values of serum potassium, sodium, calcium, phosphorus, and magnesium were 1.3, 128, 1.44, 0.20 and 0.38-mmol/L, respectively and creatine kinase (CK) increased to 13-517-U/L. The patient was diagnosed with electrolyte disorder and rhabdomyolysis. After 14 days of treatments with intravenous and oral supplementation of potassium, magnesium, calcium, and phosphorus, as well as oral spironolactone, the levels of serum potassium, sodium, calcium, phosphorus, and magnesium were 4.1, 141, 2.31, 1.13, and 0.67-mmol/L, respectively. The patient′s muscle strength recovered well and the patient could walk autonomously.
  • Wang Na, Xu Enxi, Pan Qiqi, Luo Can
    Abstract ( ) PDF ( )
    A 4-month-old premature infant with broncho-pulmonary dysplasia was hospitalized and received imipenem and cilastatin sodium combined with erythromycin for severe pneumonia. During hospitalization, erythromycin was stopped because of exacerbation of infection and replaced by vancomycin hydrochloride 60-mg dissolved in 5% glucose injection 15-ml by an IV infusion at a speed of 60-mg/h. About 10-minutes of vancomycin treatment, the infant developed cry and noisy and facial flushing. Then the infusion speed was slowed down, but the infant was still crying and his skin erythema increased, which gradually fused into pieces on his neck, chest and limbs. And his heart rate increased to 160 beats/min. Red man syndrome induced by vancomycin was considered. Vancomycin was stopped immediately and no antiallergic agents were given. About one hour later, the skin rash disappeared gradually and the heart rate decreased to 140 beats/min. The next day, the skin color returned to normal. Then teicoplanin combined with imipenem and cilastatin sodium were given according to the results of drug sensitivity test in sputum culture. The rash did not recur. Two weeks later, his pneumonia improved and he was discharged.
  • Zeng Dayong, Dong Jiashan, Huang Pinfang, Wang Changlian, Lin Rongfang
    Abstract ( ) PDF ( )
    A 65-year-old male patient was treated with pyridostigmine bromide tablets (30-mg thrice daily), azathioprine tablets (75-mg twice daily), and prednisone acetate tablets (15-mg once daily) for myasthenia gravis. Two months later, the patient developed abdominal pain, nausea, and vomiting. The laboratory tests showed the blood lipase (LPS) 909-U/L and the urine amylase (AMS) 3-838-U/L. The results of abdominal ultrasonography and imaging examination were consistent with the manifestations of pancreatitis. Above-mentioned drugs were not stopped and the patient was treated according to the conventional treatment regimen of acute pancreatitis. However, the symptoms did not improved significantly. On the 11th day after the onset of the disease, he received subcutaneous infusion of octreotide injection,intravenous infusion of pantoprazole sodium for injection, oral metronidazole, and supportive treatments such as fluid supplement and correction of water electrolyte disorders. The laboratoty tests the next day showed that the patient′s blood LPS was 3-332-U/L and AMS was 139-U/L. The acute pancreatitis was considered to be related to azathioprine tablets. Then the drug was stopped and other treatments were continued. The patient′s symptoms improved quickly. Four days later, LPS was 546-U/L and AMS was 49-U/L.
  • Wei Huabo, Shu Cheng, Li Lan, Dong Yang
    Abstract ( ) PDF ( )
    A 75-year-old male patient received an IV infusion of lappaconitine hydrobromide for injection 4-mg dissolved into 5% glucose injection 250-ml once daily due to bone metastases of lung cancer. After a single time of lappaconitine treatment, the patient developed muscle tremor mainly in the limbs, which was obvious in the sitting and standing positions and disappeared after lying flat. After 2 times of lappaconitine treatment, the muscle tremor was aggravated and he was unable to take care of himself due to tremor, showing that his hands could not hold things and walking was difficult. No other abnormal signs were found except the increase of muscle tension. The extrapyramidal symptoms (Parkinson-like symptoms) induced by lappaconitine was considered. Then lappaconitine was stopped and other treatments continued. About 24-hours of lappaconitine withdrawal, the patient′s muscle tremor disappeared. After 8 days of observation, his symptoms did not recur.
  • Liu Ying, Zhang Xian, Li Pengmei
    Abstract ( ) PDF ( )
    A 3-day-old newborn received an IV infusion of cefepime 0.16 g dissolved in 5% glucose injection 100-ml once per 12-hours for infectious jaundice. On the 6th day, the infant developed skin redness on the left lateral canthus, neck, and armpits. Erosion and large pieces of epidermal detachment occurred on the armpit skin. The area of skin exfoliation was about 2-cm×2.5-cm. It was considered to be exfoliative dermatitis induced by cefepime. Cefepime was discontinued, berberine was dissolved in water for bathing, and erythromycin ointment was used externally. Three days later, the skin erosions improved markedly, no new skin exfoliation occurred, jaundice subsided obviously. At 1 month of follow-up, the jaundice completely disappeared and the skin lesion healed.