药学

临床药物治疗学

朱茉莉

河南医药大学

老年化脓性脑膜炎；美罗培南；药物相互作用；个体化用药

本研究以一例 66 岁有长期烟酒嗜好的老年男性化脓性脑膜炎患者为对象，探讨其综合治疗的合理用药策略。患者因言语不利、头痛、抽搐入院，经脑脊液检查（有核细胞计数 1400×10^6/L，潘氏试验阳性）及头颅 MRI 确诊后，予美罗培南抗感染（初始 1g q8h ivgtt，后增至 2g q8h ivgtt），甘露醇联合甘油果糖交替脱水降颅压；基于药物相互作用风险，将抗癫痫药物由丙戊酸钠改为卡马西平并优化剂量。研究重点分析美罗培南的选择依据与个体化剂量调整、脱水药物肾毒性监护要点，以及抗感染与抗癫痫药物相互作用的识别与规避方案。结果显示，结合老年患者生理特点，通过实验室检查、影像学结果及治疗药物监测实施个体化用药，可有效提升疗效、降低不良反应风险，为老年化脓性脑膜炎临床用药管理提供实践参考。

This study focuses on a 66-year-old elderly male patient with purulent meningitis and a long history of smoking and alcohol consumption, exploring rational medication strategies for his comprehensive treatment. Admitted due to slurred speech, headache, and convulsions, he was diagnosed via cerebrospinal fluid examination (nucleated cell count 1400×10^6/L, Pandy's test positive) and cranial MRI. Meropenem was administered for anti-infection (initially 1g q8h ivgtt, later increased to 2g q8h ivgtt), and mannitol combined with glycerol fructose was alternately used for dehydration and intracranial pressure reduction. Owing to drug-drug interaction risks, the antiepileptic drug was switched from sodium valproate to carbamazepine with dosage optimization. The study emphasizes meropenem's selection basis and individualized dosage adjustment, renal toxicity monitoring of dehydrating drugs, and identification and avoidance of anti-infective-antiepileptic drug interactions. Results show that individualized medication based on elderly patients' physiological characteristics, laboratory tests, imaging findings, and therapeutic drug monitoring effectively improves efficacy and reduces adverse reaction risks, providing practical reference for clinical medication management of elderly purulent meningitis.

临床药物治疗学、临床药理学

本案例旨在通过分析一例老年化脓性脑膜炎患者的药物治疗过程

研究生阅读案例材料，了解患者的基本信息、病情进展及治疗方案。学生可以通过《临床药物治疗学》线上课程提前学习每节课的内容。

问题：在化脓性脑膜炎的治疗中，美罗培南的初始剂量为1g q8h，后调整为2g q8h。请结合患者的年龄、肝肾功能状态，分析剂量调整的依据，并讨论在肾功能不全患者中如何进一步优化美罗培南的剂量。问题：美罗培南与丙戊酸钠的相互作用导致丙戊酸钠血药浓度下降，增加了癫痫发作的风险。请分析这种相互作用的机制，并提出替代抗癫痫药物的选择及其剂量调整策略。问题：甘露醇是常用的脱水降颅压药物，但其长期使用可能导致肾毒性。请讨论如何通过交替使用甘油果糖、控制剂量和输注速度等措施，减少甘露醇的肾毒性风险，并设计一个脱水药物使用的监测方案。