Article(id=1291707037587628380, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1291706987964822180, articleNumber=null, orderNo=null, doi=10.13699/j.cnki.1001-6821.2025.21.019, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1747238400000, receivedDateStr=2025-05-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1785896556517, onlineDateStr=2026-08-05, pubDate=1763308800000, pubDateStr=2025-11-17, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1785896556517, onlineIssueDateStr=2026-08-05, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1785896556516, creator=13701087609, updateTime=1785896556516, updator=13701087609, issue=Issue{id=1291706987964822180, tenantId=1146029695717560320, journalId=1246415772164075586, year='2025', volume='41', issue='21', pageStart='3001', pageEnd='3150', issueExtLink='null', onlineDate='null', pubDate='1763308800000', pubDateStr='2025-11-17', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1785896544684, creator='13701087609', updateTime=1785896721343, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1291707729324826977, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1291706987964822180, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1291707729324826978, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1291706987964822180, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3116, endPage=3119, ext={EN=ArticleExt(id=1291707037826703709, articleId=1291707037587628380, tenantId=1146029695717560320, journalId=1246415772164075586, language=EN, title=A pharmaceutical practice case of individualized treatment for Pneumocystis jirovecii pneumonia after kidney transplantation guided by therapeutic drug monitoring, columnId=1246531412023730850, journalTitle=Chinese Journal of Clinical Pharmacology, columnName=Medication Comment, runingTitle=null, highlight=null, articleAbstract=

This case report describes an elderly patient who underwent kidney transplantation and was receiving long-term immunosuppressive therapy. The patient was admitted with persistent fever and pneumonia, and empirical antimicrobial therapy with trimethoprim-sulfamethoxazole (TMP-SMZ) (1 440 mg q8 h, oral) was initially administered. Considering the patient’s renal function and immunosuppressive status, the clinical pharmacist adjusted the dosage of TMP-SMZ to 960 mg q8 h based on the population pharmacokinetic (PopPK) model. Therapeutic drug monitoring (TDM) was performed to closely monitor the peak drug concentrations, with results showing SMZ at 134 μg·mL^-1 and TMP at 4.84 μg·mL^-1, which were consistent with the concentrations predicted by the PopPK model and fell within the therapeutic window. This validated the scientific rationale and appropriateness of the adjusted dose. In coordination with the adjusted immunosuppressive regimen, the patient’s condition gradually improved, leading to eventual discharge in stable condition. Through this case, the clinical pharmacist provided comprehensive individualized pharmaceutical care, ensuring the rationality, effectiveness and safety of treatment through precise drug dosage regulation and dynamic monitoring during the treatment process. This case also contributed to the standardization and rationalization of clinical medication for post-kidney transplant Pneumocystis jirovecii pneumonia (PJP) patients while enhancing the pharmacist’s professional skills and value.

, authors=Ling-ling YU^1a, Ying-qiu YING^1a, Wei-long SHI^1a, Ming LU^{1b, 1c}, Ping YANG^1a, Jia-jia ZHENG^1d, Rong-sheng ZHAO^1a, authorsList=Ling-ling YU, Ying-qiu YING, Wei-long SHI, Ming LU, Ping YANG, Jia-jia ZHENG, Rong-sheng ZHAO, authorCompany=null, correspAuthors=Rong-sheng ZHAO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1291707038237745502, articleId=1291707037587628380, tenantId=1146029695717560320, journalId=1246415772164075586, language=CN, title=1例基于治疗药物监测指导肾移植术后耶氏肺孢子菌肺炎个体化治疗的药学实践, columnId=1246531412271194800, journalTitle=中国临床药理学杂志, columnName=用药点评, runingTitle=null, highlight=null, articleAbstract=

1例肾移植术后长期接受免疫抑制治疗的老年患者，因持续发热伴肺炎入院，初始给予复方磺胺甲噁唑（TMP-SMZ）（1 440 mg q8 h，口服）进行经验性抗感染治疗。临床药师综合考量患者肾功能以及免疫抑制状态，基于群体药代动力学（PopPK）模型将TMP-SMZ剂量下调至960 mg q8 h。同时，通过治疗药物监测（TDM）对给药后的峰浓度进行严密监测，结果显示甲氧苄啶（TMP）为4.84 μg·mL^-1，磺胺甲噁唑（SMZ）为134 μg·mL^-1，与PopPK模型预测的结果相符且处于治疗窗内，验证了调整后剂量的科学性与合理性。在调整免疫抑制方案的协同作用下，患者病情逐渐改善，最终好转出院。临床药师通过本案例全程提供个体化药学服务，从药物剂量精准调控到治疗过程动态监测，全方位保障了治疗的合理性、有效性与安全性，促进肾移植术后耶氏肺孢子菌肺炎（PJP）患者临床用药的规范化与合理化，同时提升自身工作能力和价值。

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余玲玲（1999-），女，硕士研究生，主要从事临床药学的相关研究

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余玲玲（1999-），女，硕士研究生，主要从事临床药学的相关研究

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