Powell S H, Lantos R L
Am J Hosp Pharm. 1981 Jan;38(1):77-8.
The results of concurrent monitoring of gentamicin therapy by a clinical pharmacist are reported. All patients in a 332-bed teaching hospital who were started on gentamicin therapy during a 72-day period were monitored. Predetermined criteria concerning maximum daily gentamicin dose based on serum creatinine and acceptable precautions for avoiding toxicity (i.e., serum creatinine, gentamicin serum level determinations) were used. Deviations from these criteria resulted in contact with the patient's physician, and specific recommendations were made by the pharmacist at that time. During this period, 120 courses of gentamicin therapy were monitored in 101 patients. Major criteria deviations were found in 15 (12.5%) courses, resulting in the contact of 10 physicians. Physicians responded to the pharmacists' recommendations in 9 (60%) of the 15 courses. It is concluded that a clinical pharmacist can interact effectively with physicians in monitoring drug therapy in the hospital.
报告了临床药剂师对庆大霉素治疗进行同步监测的结果。对一家拥有332张床位的教学医院中在72天期间开始接受庆大霉素治疗的所有患者进行了监测。采用了基于血清肌酐的每日最大庆大霉素剂量的预定标准以及避免毒性的可接受预防措施（即血清肌酐、庆大霉素血清水平测定）。与这些标准的偏差导致与患者的医生联系，当时药剂师提出了具体建议。在此期间，对101名患者的120个疗程的庆大霉素治疗进行了监测。在15个（12.5%）疗程中发现了主要标准偏差，导致与10名医生进行了联系。在这15个疗程中，9个（60%）疗程的医生对药剂师的建议做出了回应。得出的结论是，临床药剂师在医院药物治疗监测中可以与医生进行有效互动。
