ABSTRACT
e: Vancomycin is a glycopeptide antibiotic separated from streptomycete, having been used as the ifrst choice to treat methicillin-resistant Staphylococcus aureus infection so far. The studies show that because of the individual difference in the metabolism of vancomycin, it is dififcult to get the trough concentration of pediatric patients severely ill or complicatedly in-fected to reach the target range (15—20 mg/L). However, with the help of therapeutic drug monitoring (TDM) of vancomycin and the pharmacokinetic/pharmacodynamic parameter (PK/PD) mode, the PK/PD parameters to achieve the precise control can be acquired by using the Bayes feedback. By a stretched review from clinical medication guide of vancomycin to the latest evidence from research, this paper fully demonstrates that renal function, weight, age, and disease state are the principal parameters to impact pediatric patient’s vancomycin metabolism and that the area under the concentration-time curve divided by the minimum inhibitory concentration (AUC/MIC)≥400 is the better cut-off value to determine vancomycin efifcacy and toxicity.
ABSTRACT
OBJECTIVE:To study the influence of calcineurin gene polymorphism on the efficacy of cyclosporine A (CsA). METHODS:The blood samples of patients treated with CsA were collected. The trough blood concentration of CsA was detected by EMIT. The genotype of PPP3CA and PPP3CB was assayed by RFLP-PCR method. The expression of NFAT-regulated gene IL-2, IFN-γand GM-CSF were measured by RT-qPCR,which were used to define the index of indirect efficacy of CsA. The relationship of gene polymorphism with CsA efficacy was study by relationship analysis and multiple factor regression method,etc. RESULTS:A to-tal of 100 blood samples were collected. There was no significant correlation between the expression of CsA efficacy-related NFAT-reg-ulated gene GM-CSF and trough concentration of CsA(rGM-CSF=-0.04,P=0.238);the expression of IL-2 and IFN-γ were negatively correlated with trough concentration of CsA significantly(rIL-2=-0.384 3,P0.05). Stratified analysis showed that among patients with immune disease underwent renal transplantation,efficacy of patients with PPP3CB rs3763679 genovariation(TC+TT) were better than those with wild-type gene (CC)(P<0.05). After the efficacy was normalized by CsA trough concentration, multivariate analysis showed that normalized efficacy of CsA was negatively correlated with gender,PPP3CB rs3763679,lactate dehy-drogenase and creatinine significantly,but positively correlated with PPP3CA rs3804358,leucocyte count,usea nitrogen,glycerin trilaurate,etc. CONCLUSIONS:PPP3CB rs3763679 gene polymorphism influence the efficacy of CsA;among patients with immune disease underwent renal transplantation,efficacy of patients with PPP3CB rs3763679 TT+TC is better than that of CC type. At the same time,gender,PPP3CA rs3804358,leucocyte count,usea nitrogen,glycerin trilaurate and other factors all can influence the nor-malized efficacy of CsA to different extent. Multiple factors should be considered when using CsA.
ABSTRACT
Objective To investigate the relationship between blood concentration of sodium valproate and the anti‐epileptic effect and the influencing factors of blood concentration of sodium valproate ,and to provide evidence for clinical individual adminis‐tration .Methods The blood concentrations of 133 cases of patients treated with sodium valproate were determined in the affiliated Yongchuan hospital of Chongqing medical university ,the monitoring results of blood concentration were statistically analyzed ,and the anti‐epileptic effect of 133 cases of patients were observed and analyzed .Results The epilepsy of 80 cases of patients were con‐trolled ,accounted for 60 .15% of the total number;in the 69 cases of patients within the effective blood drug concentration (50-100 mg/L) ,the epilepsy of 51 cases of patients were controlled ,accounting for 38 .35% .In the 44 cases of patients whose blood drug concentration were less than 50mg/L ,the epilepsy of 26 cases of patients were not controlled .The distribution of blood concentra‐tion between men and women were similar .The blood concentrations among each age group were different ,the blood concentrations of 52 .87% patients in the adult group were below or above therapeutic range that were 39 .13% in the minor group .The adverse reactions were increase with the increase of blood concentration .Conclusion There are differences between the blood concentrations of sodium valproate and clinical effect ,the reasonable individual administration should be conducted according to the patient′s blood concentrations of sodium valproate ,the epilepsy control situation of patients and the patients′age .
ABSTRACT
OBJECTIVE: To provide reference for the clinical pharmacists participating in the treatment of artery stent implantation in patients with stent thrombosis. METHODS: Through participating in the course of treatment for an artery stent implantation in patients with stent thrombosis, combining with the disease characteristics of the patient, medication history and adverse drug reactions, clinical pharmacist suggested that doctors should select appropriate drugs for the patient, and the patient should be provided with individualized pharmaceutical care. RESULTS: Clinical pharmacists use pharmacy expertise, with genetic testing and other means to assist clinicians for patients to develop individualized dosing regimen to protect the patients medication safety. CONCLUSION: Clinical pharmacists have their own advantages in providing individualized pharmaceutical care for patients. They play an important role in the rational use of drugs.
ABSTRACT
OBJECTIVE: To study appropriate working model and service platform of drug administration, in order to fill the gap in the field of individualized administration in rudimental hospitals. METHODS: We investigated the clinical demand in pharmaceutical service via clinical practice and survey, and designed individualized administration, developed related pharmaceutical service, to contribute pharmaceutical service platform based on individualized drug administration. RESULTS: Pharmaceutical service platform based on individualized doing in patients with renal dysfunction was established, by which pharmacist got effectively involved in the making and optimization of clinical dosing regimen, the levels of drug therapy was improved, and patients were treated safely, effectively, economically and reasonably. CONCLUSION: Pharmaceutical service platform based on individualized dosing is easily adopted in basic hospital, and it is an efficient carrier by which pharmacist take part in pharmaceutical cares.