1例45岁男性患者，以“左侧桥小脑角区(CPA)占位”入院，行左CPA肿瘤切除术后持续发热。痰培养为耐甲氧西林金葡菌感染，根据药敏试验给予替考拉宁治疗后仍有发热，症状未缓解，脑脊液检查示颅内感染。临床药师依据病原学检查、药代动力学特点以及结合相关文献资料对抗感染治疗方案提出了合理化建议，建议临床医生将替考拉宁替换为万古霉素，并在病情控制不佳的情况下调整万古霉素给药剂量，患者治疗6日后，感染得到控制。%One 45-year-old male with left cerebellopontine angle (CPA) lesions was sent to hospital. The patient had a fever and fast heart rate after surgery. The patient was administrated teicoplanin based on drug sensitive test. But the symptom was not controlled and the intracranial infection was found after examination of cerebrospinal fluid. Clinical pharmacist suggested replacing teicoplanin with vancomycin according to the information of etiological examination, pharmacokinetic characteristic and relevant data. In the course of treatment clinical pharmacist recommended to adjust vancomycin’s dosage and the infection was controlled finally.
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