【病例学习第9期】They Often Travel Together

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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They Often Travel Together

NG, a 21-year-old college student, presents to an urban sexually transmitted disease clinic complaining of burning and spontaneous, purulent urethral discharge. He admits to having unprotected sex about a week ago. NG’s doctor makes the diagnosis of gonococcal urethritis and explains to him that an injection of an antibiotic called ceftriaxone (125 mg) will be needed to cure the infection. A few minutes later, a nurse returns, administers the injection, and hands NG a prescription for doxycycline 100 mg twice daily for 7 days. Somewhat confused, NG takes the prescription and brings it to the pharmacy to be filled. NG explains to the pharmacist that he was just treated for gonorrhea with “a shot of antibiotics” and asks, “Why do I need to take more antibiotics? Won’t the shot work?”

How should the pharmacist respond?


ANSWER
The pharmacist should reassure NG that the antibiotic injection he received is 99% effective in curing gonococcal urethritis; however, it is common for patients with gonorrhea to have a concurrent chlamydial infection (C trachomatis) as well (in many areas >20% of the time). The pharmacist should explain to NG that although it is not known whether he has chlamydia, it is common practice to treat for it because he was diagnosed with gonorrhea. The pharmacist also should reassure NG that doxycycline is a recommended drug for this purpose and remind him of the importance of taking all of the antibiotic.


以下为翻译后的内容感谢“fjc”提供，欢迎大家对翻译结果进一步完善。


NG是一名21岁的大学生，他因下体灼热感与脓性的尿道分泌物而求诊于一所性传播疾病专科医院。他坦言，大约一个星期前曾有过未采取保护措施的性行为。他的医生诊断为淋球菌性尿道炎，并告知为治疗感染需要注射抗生素头孢曲松（125毫克）。几分钟后，一名护士回来为NG注射了该药物，同时给了NG一张处方：强力霉素100毫克，每天两次，连服7天。NG有些困惑地带着处方来到药房。他向药师说明他刚刚才针对淋病治疗注射了一定剂量的抗生素，他问药师，“为什么我还需要口服抗生素？难道刚刚的注射治疗没有起作用吗？
药师应如何回答他的疑问？

药师首先应告诉NG他所注射的抗生素对于淋球菌性尿道炎是99％有效的，但是，淋病患者普遍同时伴有衣原体感染（沙眼衣原体），这种情况的可能性大于20%。药师应该向NG解释，虽然他是否有衣原体感染尚不明确，但是鉴于其已经诊断为淋病，按常规是需要对此进行治疗的。药师还应向NG说明，强力霉素是这种治疗方法的推荐药品，并且提醒他抗生素全程足量使用的重要性。

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