CAJ | 학술논문

1例47岁男性患者因“肺曲霉病”住院治疗。因抗真菌药敏试验显示耐药或用药后治疗效果欠佳及肝功能异常而先后停用卡泊芬净和伏立康唑。换用两性霉素B脂质体静脉滴注治疗病灶吸收缓慢，且肾功能有受损趋势。给予联合两性霉素B（AmB）雾化吸入治疗，因出现呛咳、咽痛等局部刺激症状而停用。临床药师认为两性霉素B雾化吸入疗效好，安全性高，局部药物浓度维持时间长，虽然局部不良反应发生率较高，但降低吸入药物浓度可以避免或减轻不良反应。建议继续联合雾化吸入两性霉素B。临床医生采纳临床药师意见，减低雾化吸入两性霉素B的浓度，待患者耐受后再逐渐提高浓度和剂量。联合给药2周后，咳嗽症状基本消失。复查纤支镜示支气管腔病灶显著减少。随访肾功能无进一步恶化。
1례47세남성환자인“폐곡매병”주원치료。인항진균약민시험현시내약혹용약후치료효과흠가급간공능이상이선후정용잡박분정화복립강서。환용량성매소B지질체정맥적주치료병조흡수완만，차신공능유수손추세。급여연합량성매소B（AmB）무화흡입치료，인출현창해、인통등국부자격증상이정용。림상약사인위량성매소B무화흡입료효호，안전성고，국부약물농도유지시간장，수연국부불량반응발생솔교고，단강저흡입약물농도가이피면혹감경불량반응。건의계속연합무화흡입량성매소B。림상의생채납림상약사의견，감저무화흡입량성매소B적농도，대환자내수후재축점제고농도화제량。연합급약2주후，해수증상기본소실。복사섬지경시지기관강병조현저감소。수방신공능무진일보악화。
A 47-year-old man was hospitalized for pulmonary aspergillosis. The use of caspofungin and voriconazole were gradually stopped because the antifungal susceptibility test indicated resistance to caspofungin, the therapeutic efifcacy was unsatisfactory and hepatic dysfunction occurred to him owing to the treatment of voriconazole. Amphotericin B (AmB) liposome was used instead by intravenous infusion. Consequently, lesions were slowly absorbed, however it’s likely to impair his renal function. The patient had local irritations such as bucking and pharyngalgia when aerosol AmB inhalation was coadministrated. So taking aerosol AmB inhalation was also stopped. Clinical pharmacist considers that aerosol inhalation of AmB has better curative effect and safety, and its local concentration can be maintained for a long time. Although the incidence rate of local adverse reaction is higher, it could be avoided or relieved by reducing the inspired concentration. So clinical pharmacist advised to continue the combination therapy with aerosol AmB inhalation, and the clinician adopted this suggestion and gradually increased dosage of inhalation according to this patient’s tolerance. His cough almost disappeared after this dosage regimen was maintained for 2 weeks. More importantly ifberoptic bronchoscopy showed that lesions in bronchial lumen reduced signiifcantly, and no deterioration of renal function was observed during follow-up.