-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
- Cosmetic Ingredient
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
It is only for medical professionals to read and refer to a summary of the table, no worries about medication! In clinical practice, infection is the most common complication in the development of end-stage liver disease, and even the cause of death in patients with end-stage liver disease.
When end-stage liver disease is complicated by fungal esophagitis, its antibacterial treatment is not that simple Next, let’s take a look at a clinical case study
.
Case review The first two days to consult a patient with end-stage liver disease and fungal esophagitis.
The patient had liver cirrhosis and fungal esophagitis
.
Clinically given routine use of fluconazole: July 2-the first dose of 400 mg, 200 mg continuous infusion, July 2 G test: 190 pg/mL, liver function classification is child-pugh C, chronic progressive renal failure: The creatinine clearance rate was 316.
566μmol/L; according to the above regimen treatment until the 8th day, the patient's G test on July 9 showed: 151.
39pg/mL
.
On the 15th day of continued treatment, the patient's G test on July 16 showed: 178pg/mL
.
It shows that although the patient has a certain curative effect on antifungal, the overall curative effect is not good, so the clinical pharmacist is asked to consult and give guidance on the treatment plan
.
According to the patient's diagnosis and treatment, the clinical pharmacist made the following analysis
.
How do patients with end-stage liver disease complicated with fungal esophagitis choose antifungal drugs? According to clinical studies, it has been found that [1] with end-stage liver disease combined with digestive system infections, the common pathogens are mainly Candida albicans, among which Candida albicans is the most common
.
The azole antifungal drug fluconazole is recommended by major guidelines and expert consensus for end-stage liver disease complicated with fungal infection
.
This is because a small amount of fluconazole is metabolized by the liver, 80% is excreted by the kidney in its original form, and the elimination half-life is 27 to 37 hours, and the half-life is significantly prolonged when renal function declines [2]
.
Although the instructions of fluconazole clearly stipulate that it has varying degrees of influence on liver and kidney function, but from the current major guidelines and clinical studies in the consensus of experts found that [1,3], fluconazole is better than other types of anti- Fungal drugs have better safety, and because of their lighter liver damage, they are especially suitable for patients with end-stage liver disease combined with Candida albicans infection
.
According to the diagnosis and treatment of this patient, the patient had end-stage liver disease with fungal esophagitis, and the pathogen was Candida albicans, namely Candida albicans.
Fluconazole was a reasonable drug choice
.
But why the patient is given fluconazole treatment, but the treatment effect is not good? Does the selected drug dosage need to be changed? How should such patients choose the dose of medication? According to the 2019 edition of the "Guidelines for the Diagnosis and Treatment of Liver Cirrhosis" [3] and "Expert Consensus on the Diagnosis and Treatment of End-Stage Liver Disease Complicated Infections" [4], patients with end-stage liver disease complicated with fungal infections should choose antibacterial drugs based on the patient's liver function.
For specific dosage adjustments, see Table 1 below: Table 1 Dosage adjustment of common antifungal drugs for patients with liver injury Note: Grade A (5-6 points): mild liver damage; Grade B (7-9 points): moderate liver damage; C Grade (≥10 points): severe liver damage
.
It can be seen from Table 1 above: In terms of safety and effectiveness, fluconazole has certain advantages over other antifungal drugs for grade C liver function; for child grade C liver function, other antifungal drugs need to be reduced or not recommended Application, but fluconazole can still be used routinely
.
Through the above comprehensive analysis, consider that the liver and kidney function of the consultation patient is in a state of failure, and the previous fluconazole treatment process is not effective
.
According to the "Guidelines for Clinical Medication of Chinese Physicians and Pharmacists" [2] For creatinine clearance greater than 50mL/min, fluconazole is given at a regular dose, and for creatinine clearance less than 11-50mL/min, fluconazole is given at half the regular dose
.
After calculation, it was found that the patient's creatinine clearance rate was about 12 mL/min
.
In the case of weighing the pros and cons, the clinical pharmacist recommends giving the patient fluconazole: 400mg (first dose), 400mg (continuous infusion); and it is recommended that the patient's renal function be monitored in time and the medication regimen should be adjusted in time
.
Finally, under this treatment plan, the patient's symptoms improved
.
The pharmacist concluded that for patients with end-stage liver disease complicated with fungal esophagitis, fluconazole should be given first.
At the same time, full consideration should be given to the specific conditions of the patient.
The appropriate dose should be given according to the patient’s liver and kidney function.
Conazole also exerts its greatest antifungal effect
.
References: [1] Liu Qian'e.
Research progress in the application of antifungal drugs in patients with moderate to severe liver damage[J].
Modern Medicine and Health,2018,034(013):1937-1939.
[2]Expert Committee on Rational Use of Medicines of the Ministry of Health.
Chinese Physician , Pharmacist's clinical medication guide [M], 2nd edition.
Chongqing: Chongqing Publishing House 2014: 209-214.
[3] Chinese Medical Association Infectious Diseases Branch.
Expert consensus on diagnosis and treatment of end-stage liver disease complicated infection.
Chinese Journal of Hepatology.
2018; 26: 568-578.
[4] Chinese Medical Association Hepatology Branch.
Guidelines for the diagnosis and treatment of liver cirrhosis[J].
Chinese Journal of Hepatology, 2019,027(011):846-865.
When end-stage liver disease is complicated by fungal esophagitis, its antibacterial treatment is not that simple Next, let’s take a look at a clinical case study
.
Case review The first two days to consult a patient with end-stage liver disease and fungal esophagitis.
The patient had liver cirrhosis and fungal esophagitis
.
Clinically given routine use of fluconazole: July 2-the first dose of 400 mg, 200 mg continuous infusion, July 2 G test: 190 pg/mL, liver function classification is child-pugh C, chronic progressive renal failure: The creatinine clearance rate was 316.
566μmol/L; according to the above regimen treatment until the 8th day, the patient's G test on July 9 showed: 151.
39pg/mL
.
On the 15th day of continued treatment, the patient's G test on July 16 showed: 178pg/mL
.
It shows that although the patient has a certain curative effect on antifungal, the overall curative effect is not good, so the clinical pharmacist is asked to consult and give guidance on the treatment plan
.
According to the patient's diagnosis and treatment, the clinical pharmacist made the following analysis
.
How do patients with end-stage liver disease complicated with fungal esophagitis choose antifungal drugs? According to clinical studies, it has been found that [1] with end-stage liver disease combined with digestive system infections, the common pathogens are mainly Candida albicans, among which Candida albicans is the most common
.
The azole antifungal drug fluconazole is recommended by major guidelines and expert consensus for end-stage liver disease complicated with fungal infection
.
This is because a small amount of fluconazole is metabolized by the liver, 80% is excreted by the kidney in its original form, and the elimination half-life is 27 to 37 hours, and the half-life is significantly prolonged when renal function declines [2]
.
Although the instructions of fluconazole clearly stipulate that it has varying degrees of influence on liver and kidney function, but from the current major guidelines and clinical studies in the consensus of experts found that [1,3], fluconazole is better than other types of anti- Fungal drugs have better safety, and because of their lighter liver damage, they are especially suitable for patients with end-stage liver disease combined with Candida albicans infection
.
According to the diagnosis and treatment of this patient, the patient had end-stage liver disease with fungal esophagitis, and the pathogen was Candida albicans, namely Candida albicans.
Fluconazole was a reasonable drug choice
.
But why the patient is given fluconazole treatment, but the treatment effect is not good? Does the selected drug dosage need to be changed? How should such patients choose the dose of medication? According to the 2019 edition of the "Guidelines for the Diagnosis and Treatment of Liver Cirrhosis" [3] and "Expert Consensus on the Diagnosis and Treatment of End-Stage Liver Disease Complicated Infections" [4], patients with end-stage liver disease complicated with fungal infections should choose antibacterial drugs based on the patient's liver function.
For specific dosage adjustments, see Table 1 below: Table 1 Dosage adjustment of common antifungal drugs for patients with liver injury Note: Grade A (5-6 points): mild liver damage; Grade B (7-9 points): moderate liver damage; C Grade (≥10 points): severe liver damage
.
It can be seen from Table 1 above: In terms of safety and effectiveness, fluconazole has certain advantages over other antifungal drugs for grade C liver function; for child grade C liver function, other antifungal drugs need to be reduced or not recommended Application, but fluconazole can still be used routinely
.
Through the above comprehensive analysis, consider that the liver and kidney function of the consultation patient is in a state of failure, and the previous fluconazole treatment process is not effective
.
According to the "Guidelines for Clinical Medication of Chinese Physicians and Pharmacists" [2] For creatinine clearance greater than 50mL/min, fluconazole is given at a regular dose, and for creatinine clearance less than 11-50mL/min, fluconazole is given at half the regular dose
.
After calculation, it was found that the patient's creatinine clearance rate was about 12 mL/min
.
In the case of weighing the pros and cons, the clinical pharmacist recommends giving the patient fluconazole: 400mg (first dose), 400mg (continuous infusion); and it is recommended that the patient's renal function be monitored in time and the medication regimen should be adjusted in time
.
Finally, under this treatment plan, the patient's symptoms improved
.
The pharmacist concluded that for patients with end-stage liver disease complicated with fungal esophagitis, fluconazole should be given first.
At the same time, full consideration should be given to the specific conditions of the patient.
The appropriate dose should be given according to the patient’s liver and kidney function.
Conazole also exerts its greatest antifungal effect
.
References: [1] Liu Qian'e.
Research progress in the application of antifungal drugs in patients with moderate to severe liver damage[J].
Modern Medicine and Health,2018,034(013):1937-1939.
[2]Expert Committee on Rational Use of Medicines of the Ministry of Health.
Chinese Physician , Pharmacist's clinical medication guide [M], 2nd edition.
Chongqing: Chongqing Publishing House 2014: 209-214.
[3] Chinese Medical Association Infectious Diseases Branch.
Expert consensus on diagnosis and treatment of end-stage liver disease complicated infection.
Chinese Journal of Hepatology.
2018; 26: 568-578.
[4] Chinese Medical Association Hepatology Branch.
Guidelines for the diagnosis and treatment of liver cirrhosis[J].
Chinese Journal of Hepatology, 2019,027(011):846-865.
