Pharmaceutical care on a patient with neurosyphilis combined with symptomatic epilepsy

HUANG Zhi-en; YAO Hui; LIANG Lei

Abstract：[ABSTRACT]One 53-year-old male patient with epilepsy was hospitalized for frequent seizures due to reducing dose of carbamazepine voluntarily, and neurosyphilis was diagnosed by blood and cerebrospinal lfuid examination. Dosage of carbamazepine was adjusted by carefully monitoring serum concentration. At the same time, the patient was treated by injecting antisyphilitic drugs. The epilepsy was controlled after treatment, and the patient discharged and transferred to the local infectious hospital for subsequent antisyphilitic treatment. Clinical pharmacists provided integrated pharmaceutical care during treatment course and appraisal of therapeutic optimization, such as antiepileptic and anti-infectious drugs. Pharmacists also suggested the drugs should be used strictly according to doctor's advice and the instructions. Rash, dizziness, blurred vision and other symptoms should be paid attention to. Blood drug concentration, blood cell count, liver and kidney function should be monitored regularly. Benzathine penicillin should not be selected because it couldn't penetrate the blood brain barrier in antisyphilitic treatment. Meanwhile pharmacists suggested penicillin should be avoided because penicillin could exacerbate seizures. At last, pharmacists recommended to use non-penicillin antibiotics (ceftriaxone) as replacement therapy.