Practice of clinical pharmacist participating in the treatment of a case of mixed shock caused by severe scrub typhus
- VernacularTitle:临床药师参与1例重症恙虫病致混合性休克的药学实践
- Author:
Xiaoyan HUANG
1
,
2
;
Jingwen XIE
1
,
2
;
Yanzhe XIA
3
;
Jia LI
3
Author Information
1. Dept. of Pharmacy，the Sixth Affiliated Hospital of Sun Yat-sen University，Guangzhou 510655，China
2. Guangzhou Huangpu District Zhongliu Institute for Biomedical Innovation，Guangzhou 510655，China
3. Dept. of Pharmacy，the First Affiliated Hospital of Sun Yat-sen University，Guangzhou 510080，China
- Publication Type:Journal Article
- Keywords:
scrub typhus;
septic shock;
cardiogenic
- From:
China Pharmacy
2025;36(5):600-605
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To provide valuable insights for the adjustment of anti-infectious regimens， identification of adverse reactions， and individualized pharmaceutical care in patients with critically severe scrub typhus. METHODS Clinical pharmacists actively participated in the pharmaceutical care process for a patient with severe scrub typhus leading to mixed shock undergoing continuous renal replacement therapy and extracorporeal membrane oxygenation. Initially， the patient received meropenem （1 g， q12 h， ivdrip）， in combination with doxycycline （0.1 g， q12 h， po）， which was later switched to meropenem （1 g， q8 h， ivdrip） along with omacycline （100 mg， qd， ivdrip） due to impaired gastrointestinal function. However， as the patient’s condition progressively deteriorated and the infection became uncontrolled， the clinical pharmacists recommended that the clinicians adjust the anti-infective regimen to meropenem （2 g， q8 h， ivdrip） combined with tigecycline （100 mg for first dose； 50 mg， q12 h for maintenance； ivdrip）. The clinicians followed the advice of the clinical pharmacists. After treatment， the patient’s symptoms exhibited significant improvement， accompanied by a notable decrease in inflammatory markers， indicating that the infection had been successfully controlled. However， due to continuously increasing bilirubin levels， in order to reduce the risk of drug-induced liver injury， the clinicians changed tigecycline to azithromycin （0.5 g， qd， ivdrip） following the recommendation of the clinical pharmacists. RESULTS Ultimately， metagenomic next-generation sequencing of the bronchoalveolar lavage fluid and blood specimens indicated that Orientia tsutsugamushi had been completely eradicated in the patient. CONCLUSIONS Tigecycline may be a viable therapeutic choice for patients with severe scrub typhus. In the context of critically ill patients with scrub typhus， combining tigecycline with azithromycin might potentially enhance the efficacy in eliminating Orientia tsutsugamushi.
