Pharmaceutical Care of Anti-infective Treatment in One Child with Purulent Meningitis,and Cerebral Abscess with Subdural Abscess
Objective:To analyze the pharmaceutical care process of anti-infective treatment in one child with purulent meningitis,and cerebral abscess with subdural abscess,and provide reference for the anti-infective treatment of clinically similar severe central nervous system infections.Methods and Results:The patient was transferred to Children's Hospital of Nanjing Medical University from external hospital because of"headache,fever,and aphasia for several days".Based on the examination results at admission and past medical history,the patient was diagnosed with purulent meningitis,and cerebral abscess with subdural abscess,and meropenem and vancomycin that could pass the blood-brain barrier were used for empiric anti-infective treatment;after nearly 30 days of treatment,the patient's body temperature basically returned to normal,and the infection indicators and speech function were also significantly improved.During the period,the next-generation sequencing indicated that the suspected pathogenic bacteria were Fusobacterium nucleatum;during pharmaceutical care,the clinical pharmacists recommended adjusting the dosage of meropenem and vancomycin based on the changes in the patient's body mass and disease conditions,and clinicians accepted the recommendations.On the 34th day of hospitalization,the patient developed granulocytopenia and mild abnormalities in liver functions,which were considered to be caused by anti-infective drugs;so burnet root leukopoietic tablets and reduced glutathione were added for symptomatic treatment.On the 50th day,MRI and CT scan showed that the child's cerebral abscess of the left frontal lobe was significantly smaller than before,but the abscess cavity was still visible.Considering that the current anti-infective treatment regimen could not completely kill the pathogenic bacteria,metronidazole was added.Five days later,the patient's conditions improved greatly and he/she was discharged.Conclusion:For children with severe central nervous system infections such as purulent meningitis and cerebral abscess with subdural abscess,clinical pharmacists should assist clinicians in selecting antibacterial drugs that can pass the blood-brain barrier;and during pharmaceutical care,clinical pharmacists should notice the patient's conditions and adjust the treatment regimens promptly to help the patients to achieve good curative effect.
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