Objective:To evaluate the anti-infective therapy in a patient with multi-site infections after brain surgery and explore the role of clinical pharmacist in the treatment. Methods:With the applications of PK/PD characteristics of drugs and the coping strategies of resistant , vancomycin combined with fosfomycin were used to treat the intracranial infection caused by methicillin-resistant Staphylococcus epidermidis with vancomycin MIC of 2 mg·L-1 , and the dynamic adjustment of antibiotics was applied to treat the pulmonary infection caused by two kinds of pathogens including MDR bacteria. Results:The intracranial infection was successfully controlled, the pulmonary infection was also under control, and the overall condition of the patient was significantly improved. Conclusion: In the medical team, clinical pharmacists should make full use of their advantages in drug characteristics to carry out clinical pharmaceutical care.

To investigate the disposition and tissue distribution of ML12 after intravenous (iv) administration in rats, the compound in plasma or in tissue was extracted into ethyl acetate under basic condition and was determined by HPLC after extracted by dilute sulfuric acid. Excitation wavelength and emission wavelength of fluorescence detection were 278 nm and 307 nm, respectively. The data were processed with the software 3P97 to calculate the main pharmaceutical parameters of ML12. At dose of 5 and 10 mg/kg, the elimination of the drug from plasma was found to be kinetically linear, but when the dosage was 20 mg/kg, a non-linear feature was observed. The highest level of ML12 was found in the kidney. Distribution of ML12 after iv administration was extensive and the concentration-time profile was found to be fitted to an open two-compartment model.
Antihypertensive Agents/*pharmacokinetics ; Biological Availability ; Chromatography, High Pressure Liquid/methods ; Kinetics ; Pharmaceutical Preparations ; Rats, Sprague-Dawley ; Spectrometry, Fluorescence/methods ; Sulfuric Acids/chemistry ; Tissue Distribution

Objective To investigate the effects of Wuzhi capsules on tacrolimus concentration in heart transplant recipients and provide evidence for individualized dose optimization of tacrolimus.Methods Forty heart transplant recipients receiving Wuzhi capsules were enrolled in this study.Tacrolimus trough concentration was compared before and after coadminstration of Wuzhicapsules.Furthermore,polymorphisms of CYP3A4 * 1G and CYP3A5 * 3 were also detected to clarify correlations between genotypes and effects of Wuzhi capsule.Results Dose-normalized concentration of tacrolimus after coadministartion with Wuzhi capsules was 2.02-fold higher than before,the results of which was not associated with CYP3A4 * 1G and CYP3A5 * 3 genotypes.Wuzhi capsule could significantly decrease the total bilimbin (T-BiL),but not other hepatic and renal function.Conclusion Dose-normalized concentration of tacrolimus in heart transplant recipients is remarkably increased by Wuzhi capsule.The elevated trough levels rarely result in hepatic and renal toxicity.Wuzhi capsule is a safe,effective,and stable drug to increase the trough concentration of tacrolimus.

Objective To investigate the adverse drug reactions (ADRs) induced by escitalopram and precautions. Methods Wanfang,CNKI,Pubmed databases were searched to retrieve information about escitalopram adverse reactions reported in the literature,focusing on analysis of adverse reactions in patients with age,sex,clinical manifestations,involved systems, etc. Results Totally,31 references were collected,and a total of 31 cases included in the review analysis.The adverse reaction rate was equivalent between the male and the female.The adverse reaction occurred a few hours to 6 months after medication,and it involved several organ systems,including the nervous system,circulatory system,endocrine system,alimentary system,urinary system,kinetic system,etc. Conclusion Escitalopram should be used according to the doctor's advice,and its amount should not be arbitrarily added.Regular monitoring of adverse reactions should be performed to ensure rational use of the drug.

To investigate the disposition and tissue distribution of ML12 after intravenous (iv) ad- ministration in rats, the compound in plasma or in tissue was extracted into ethyl acetate under basic condition and was determined by HPLC after extracted by dilute sulfuric acid. Excitation wavelength and emission wavelength of fluorescence detection were 278 nm and 307 nm, respectively. The data were processed with the software 3P97 to calculate the main pharmaceutical parameters of ML12, At dose of 5 and 10 mg/kg, the elimination of the drug from plasma was found to be kinetically linear, but when the dosage was 20 mg/kg, a non-linear feature was observed. The highest level of MLI2 was found in the kidney. Distribution of MLI2 after iv administration was extensive and the concentration-time profile was found to he fitted to an open two-compartment model.

Objective To explore the clinical manifestations ,risk factors and treatment of antibiotic asso-ciated diarrhea(AAD)in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treat-ment,28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient′s age,and time, APACHE Ⅱ,category,combination therapyof antibacterial,and invasive operations. We should pay more atten-tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti-bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.

Objective:To establish an FPLC-MS/MS method for the determination of fluvoxamine in human plasma. Methods:The separation was performed on an Inertsil? ODS-SP column(2. 1 × 100 mm, 3 μm). The mobile phase was acetonitrile-2 mmol· L-1 ammonium acetate (45: 55, v/v) containing 0. 1% formic acid at a flow rate of 0. 3 ml·min-1 . Lansoprazole was used as the internal standard( IS) . Electrospray ionization ( ESI) source was applied and operated in a positive ion model. Multiple reaction moni-toring (MRM) model with the transitions of fluvoxamine m/z 319. 1→m/z 69. 8 and lansoprazole m/z 370. 2→m/z 252. 1 was used to quantify fluvoxamine and IS, respectively. Results:In human plasma, the standard curve was linear within the range of 1-100 μg· L-1 . The lower limit of quantification of fluvoxamine( LLOQ) was 1μg·L-1 . The intra-day RSD was less than 5%, the inter-day RSD was less than 10%, and the method recovery was 85%-95%. Conclusion:The method is simple, sensitive, accurate and reproduci-ble. It is applicable in the pharmacokinetic study of fluvoxamine for clinical pharmacokinetics and bioequivalence studies.

Objective:To establish an FPLC-MS/MS method for the determination of fluvoxamine in human plasma. Methods:The separation was performed on an Inertsil? ODS-SP column(2. 1 × 100 mm, 3 μm). The mobile phase was acetonitrile-2 mmol· L-1 ammonium acetate (45: 55, v/v) containing 0. 1% formic acid at a flow rate of 0. 3 ml·min-1 . Lansoprazole was used as the internal standard( IS) . Electrospray ionization ( ESI) source was applied and operated in a positive ion model. Multiple reaction moni-toring (MRM) model with the transitions of fluvoxamine m/z 319. 1→m/z 69. 8 and lansoprazole m/z 370. 2→m/z 252. 1 was used to quantify fluvoxamine and IS, respectively. Results:In human plasma, the standard curve was linear within the range of 1-100 μg· L-1 . The lower limit of quantification of fluvoxamine( LLOQ) was 1μg·L-1 . The intra-day RSD was less than 5%, the inter-day RSD was less than 10%, and the method recovery was 85%-95%. Conclusion:The method is simple, sensitive, accurate and reproduci-ble. It is applicable in the pharmacokinetic study of fluvoxamine for clinical pharmacokinetics and bioequivalence studies.

OBJECTIVE： To investigate the characteristics and regularity of hepatotoxicity induced by quinolones， and to provide reference for clinical use of drug safely. METHODS： Using “quinolone” “floxacin” “hepatotoxicity” “hepatic injury”as retrieval words， relevant literatures about hepatotoxicity induced by quinolones were retrieved from domestic and foreign databases as CNKI， Wanfang， VIP， PubMed （during database establishment to 31th， Dec. 2017）. Those literatures were summarized and analyzed. RESULTS： A total of 59 valid literatures were collected， including 61 cases of hepatotoxicity induced by quinolones， 8 types of drugs as ciprofloxacin， moxifloxacin， ofloxacin， lomefloxacin， norfloxacin， levofloxacin， gatifloxacin and enoxacin. Ciprofloxacin， levofloxacin， moxifloxacin and ofloxacin were the most common drugs that caused hepatotoxicity， involving 19， 13， 11， 7 cases， respectively； accumulative constitute ratio was 81.97％. The ratio of male to female was 1.54 ∶ 1， and hepatotoxicity always happened at the age of 61 to 80 （30 cases， 49.18％）. Primary diseases of 46 cases were single disease （75.41％）， and mainly were infection of respiratory system and urogenital system. There were 15 cases of combined disease （24.59％）. Thirty-one cases used quinolones alone， most of which was ciprofloxacin. There were 30 cases of drug combination. Thirty-four cases were given drug intravenously and mainly were domestic cases. The hepatotoxicity first occurred within 10 minutes after administration and at the latest 8 weeks after administration. Forty-nine patients suffered from hepatotoxicity within 10 days after medication， accounting for 80.33％. Besides general fatigue， nausea and vomiting， clinical symptoms also included abnormal elevation of alanine aminotransferase， aspartate aminotransferase and total bilirubin，etc. Fifty-four patients were improved after withdrawal or symptomatic treatment， while 7 patients died. The results of causality evaluation of drug-induced hepatic injury showed that there were 4 probably association cases， 45 likely association cases and 12 possible association cases. CONCLUSIONS： The hepatotoxicity caused by quinolones is related to drug variety， patient’s age， primary disease， drug combination and route of administration， and mostly occurs within 10 days after administration. Great importance should be attached to patient’s liver function indexes， strengthen medication monitoring， and carefully combined use of drugs.