OBJECTIVE:To explore the value of clinical pharmacists in rational use of drugs and the guidance role of the phar-maceutical theory on clinical practice. METHODS:Through participating in the course of treatment of patients with nephrotic syn-drome associated with urinary tract infection,an analysis was performed with regard to hormonal therapy,anti-infective therapy, anticoagulant therapy,blood lipid-regulating therapy and antihypertensive therapy,and the established regimens were adjusted based on clinical efficacy and changes in patients’pathogenetic condition. RESULTS:Clinical pharmacists suggested that the pa-tients should take hormone drugs regularly and their side effects should be prevented by using vitamin D3 and anti-acid agents;piperacillin/ tazobactam or cefoperazone/ sulbactam should be used as anti-infective therapy;when using warfarin,the concurrent-ly used low molecular heparin or piperazine ferulate should be reduced in dosage;it is better for fluvastatin used alone as lipid-reg-ulating therapy;perindopril antihypertensive therapy should be started in small dose for slow blood pressure reduction. The optimiza-tion of regimen and education among patients resulted in improved clinical outcome and fewer adverse drug reactions. CONCLU-SIONS:Clinical pharmacists optimize the medication regimen in patients with nephrotic syndrome associated with urinary tract in-fection by applying pharmacy theoretical knowledge,providing individualized pharmaceutical care and promoting rational use of drugs.%目的：探讨临床药师在合理用药中的价值以及药学理论对临床实践的指导作用。方法：通过参与1例肾病综合征并发尿路感染患者的治疗过程，主要从激素治疗、抗感染治疗、抗凝治疗、调血脂治疗、降压治疗等方面进行分析，根据临床疗效和病情变化及时调整既定方案。结果：临床药师建议，患者需规律服用激素药物，并用维生素D3及抑酸药对抗其副作用；以哌拉西林/他唑巴坦或头孢哌酮/舒巴坦抗感染治疗；华法林抗凝时应适时减少合用药低分子肝素或阿魏酸哌嗪的用量；氟伐他汀调血脂治疗宜单独使用；培哚普利降压治疗应从小剂量开始应用，缓慢降压。通过优化给药方案和对患者的宣教，提高了临床治疗效果，减轻了药品不良反应。结论：临床药师运用药学知识优化肾病综合征并发尿路感染患者的用药方案，提供了个体化药学服务，促进了临床合理用药。
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