摘要
1例诊断为血液恶性肿瘤肺毛霉菌病的7岁儿童,给予两性霉素B进行抗感染治疗,用药期间血肌酐进行性升高,考虑为两性霉素B所致的药物不良反应,下调两性霉素B剂量后,胸部CT示左肺团块影较前呈增大趋势,考虑药物剂量不足、疗效欠佳,但再次上调剂量肾损害风险增加。经综合评估后,停用两性霉素B,改为泊沙康唑混悬液口服序贯抗真菌治疗,且出院后持续服用,定期行化疗方案,并随访左肺结节变化情况。患儿出院5个月后,胸部CT示左肺团块影基本吸收,治疗有效。结合本例患儿的抗感染治疗方案,本文对儿童毛霉菌病的治疗药物选择、用法用量及不良反应等进行了分析讨论。儿童毛霉菌病的抗感染治疗可能需要更高的个性化剂量及严密的监测才能保证安全性及有效性。
A 7-year-old child diagnosed with pulmonary mucormycosis,a hematologic malignant tumor,was given amphotericin B as anti-infective therapy.However,the serum creatinine increased progressively during the treatment,which was considered to be the adverse drug reaction caused by amphotericin B,so the dose of amphotericin B was down-regulated.After the dose reduction,chest CT showed that the left lung mass shadow was increasing compared with before.Considering that the drug dose was insufficient,the efficacy was not good,but the risk of renal impairment increased when the dose was up-regulated again.Therefore,after comprehensive evaluation,amphotericin B was discontinued and posaconazole oral suspension was used as sequential antifungal therapy.After discharge,the child continued to take posaconazole oral suspension as antifungal therapy,received regular chemotherapy regimen,and the changes of left pulmonary nodules were followed up.Five months after discharge,the child's chest CT showed that the left lung mass shadow was basically absorbed and the treatment was effective.In this paper,the selection,usage and dosage,adverse reactions of therapeutic drugs for children with mucormycosis were analyzed and discussed based on the anti-infective treatment plan for this child,and the anti-infective treatment for children with mucormycosis needed higher personalized dosage and strict monitoring to ensure safety and effectiveness.
作者
吕佳窈
杨敏
Lü Jiayao;Yang Min(Ziyang Psychiatric Hospital,Ziyang 641300,China;Mianyang Central Hospital,Mianyang 621000,China)
出处
《实用药物与临床》
CAS
2024年第5期391-395,共5页
Practical Pharmacy and Clinical Remedies
关键词
儿童
血液恶性肿瘤
毛霉菌病
抗感染治疗
Children
Hematologic malignancy
Mucormycosis
Anti-infective therapy
