Sun was assigned to work with Dr. Hu from the Department of Neurology to treat patients. Sun Lien is quite accustomed to this arrangement-this is what a regular training should look like.

But Dr. Hu Chunbo doesn't think so. In his opinion, Sun Lien is simply the male protagonist on the Internet that he usually watches. is not very old, but his ability is not small. The older generation has worked hard to figure out things that they can't figure out for a long time, and he can break through the key in one sentence. This is not only the male protagonist, but also a scholar.

When the protagonist has to follow him for treatment, Dr. Hu is under more pressure than his own tutor to follow the group throughout the process. After all, the male protagonists on the Internet are not people, and there are many *** women who kill the whole family at every turn. Dr. Hu's wife is beautiful, and his daughter is in the second year of high school, so it's time to stand out and be good-looking. He was worried for a full five seconds before he came to his senses, this was his real life, not some plot on the Internet.

"Dr. Sun, this is the patient's test report. Hu Chunbo took the report and walked in front of Sun Lien with some trepidation. He had read these reports several times or even a dozen times. Hu Chunbo didn't think he could see any valuable hints in it. But if Sun Lien could see the problem at a glance...... There's no place to put your own face.

Even if it is another three months, everyone will go back to work. Hu Chunbo also felt that his big face with nowhere to put would be hot for several years - he couldn't even do the regular training of the emergency internal medicine department, and he had worked to the stomach of a dog for so many years?

Fortunately, after Sun Lien read the inspection report, he did not point out any terrible mistakes. He just nodded seriously and said to Hu Chunbo, "What about the medicine?"

"I'm going to consult with the licensed pharmacists in our hospital. Hu Chunbo replied, "The medicine brought by the team this time is not too much, and there are only four special use grades." Tyneng, meropenem, linezolid and vancomycin. He was a little worried, "Actually, I think your combination of drugs is good, but I don't know if there is a combination between doxycycline and these four antibiotics." ”

The combination of drugs is indeed a very troublesome thing. There are so many types of antibiotics used in clinical practice that it is impossible for doctors to remember the combined effects of each drug with others. To find a suitable combination of drugs, doctors must either consult various pharmacopoeias and drug inserts and even the latest research reports, or ...... Call our licensed pharmacist directly.

"Antimicrobial therapy with relatively small doses of doxycycline, followed by broad-spectrum antibiotics to treat the infection, focuses on controlling progression and determining the type of bacteria susceptible to through experimental treatments. Sun Lien was afraid that his previous explanation was not clear enough, so he emphasized, "The use of doxycycline should be able to buy us enough time so that in case quinolones are ineffective, we can also switch to other antibiotics in time." ”

"I had something else in mind. Dr. Hu pondered for a long time and put forward his opinion, "Ceftriaxone is a third-generation cephalosporin, but it is not very effective against gram-negative bacilli that produce ESBLs - her infection is obviously not methicillin-resistant Staphylococcus aureus, after all, that thing is relatively easy to cultivate." ”

Sun Lien nodded, this logic was consistent with what everyone had discussed in the restaurant before.

"So, the most likely pathogen at the moment is the gram-negative bacilli that produce ESBLs. "It's useful to talk about this kind of thing, but you have to say it yourself. If you think about it hundreds of times in your heart, it is better to say it once. "At present, among the four restricted-use antibiotics we have in reserve, Tyneng is not suitable for meningitis, and linezolid is mainly used for the treatment of gram-positive cocci - vancomycin can only be used to fight methicillin-resistant Staphylococcus aureus infection, so the only thing we can use is meropenem. ”

Sun Lien has been at a loss since "Taineng is not suitable for meningitis". Linezolid he didn't even use once. Seeing Dr. Hu talking eloquently in front of him, Sun Lien could only nod in agreement. It can be seen that Hu Chunbo has already moved the idea of using restricted-use grade antibiotics, and has also consulted the instructions of the four drugs in detail.

"Even better, meropenem is excreted mainly through the kidneys. This does not place any more strain on the patient's liver, even with doxycycline. "The burden of doxycycline on the liver rises rapidly as the dosage of the drug changes. However, we use doxycycline mainly for antibacterial rather than bactericidal, so the dose is not too large. ”

Sun Lien nodded, he really understood this part.

There are basically only two ways to metabolize drugs, one is to metabolize them in the liver and then excrete them with feces. The other is metabolized by the kidneys, which enters the urine and is excreted from the body.

Doxycycline needs to be metabolized in the liver, so it is also more damaging to the liver. Therefore, the drug description specifically states that this drug cannot be used in combination with other drugs with liver toxicity.

At present, there are only meropenem antibiotics that are excreted by the kidneys and are sensitive to gram-negative bacilli that produce ESBLs.

"Then meropenem. Sun Lien nodded, this plan at least from Sun Lien's point of view, there was nothing wrong with it. "I'm going to notify the pharmacy now?"

"Then where can I do it...... Dr. Hu smiled bitterly, "This is a restricted-use grade antibiotic, and it has to be approved by Director Liu." ”

"Huh?" Sun Lien blinked, Meropenem he hadn't used it, but Taineng Sun Lien had used it more than once. In the past, when Sun Lien opened Taineng, there was never such a process.

Hu Chunbo was also stunned by Sun Lien's bewilderment, "This ...... You have restricted the use of grade antibiotics in your hospital, and you don't need the approval of the department director?"

Sun Lien thought about it seriously, and then shook his head, "I...... When I used to use it, the prescription was straight down. ”

"What?" Hu Chunbo looked shocked, "Have you prescribed this medicine?"

"That's right. Sun Lien continued to nod, and then said embarrassedly. "When I didn't take the medical exam before, I used Director Liu's prescription authority, and later when Director Liu came to Africa, I used the prescription authority of other doctors in the group......"

"Then when you think you need it, you can prescribe restricted-use grade antibiotics without the approval of the director?" Hu Chunbo no longer had a shocked expression on his face, he began to look full of envy, "I said Xiao Sun......" He lowered his voice and asked seriously, "Do you still recruit doctors in the fourth hospital now?"