Fluconazole and Amphotericin B for Cryptococcal Meningitis
Fluconazole and Amphotericin B for Cryptococcal Meningitis
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氟康唑和两性霉素 B 治疗隐球菌性脑膜炎
DOI：
10.1177/106002809603001209
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发表时间：
1996
影响因子：
2.9
通讯作者：
M. Gelfand
中科院分区：
文献类型：
--
作者：
Amy B Clark;B. Lobo;M. Gelfand
目的：描述1例隐球菌性脑膜炎患者联合应用雷帕霉素B和氟康唑治疗。病例总结：1例41岁女性隐球菌性脑膜炎患者，未感染HIV，因单用阿替霉素B无效且不能耐受阿替霉素B与氟胞嘧啶联合治疗，而接受阿替霉素B和氟康唑联合治疗。她在临床上有所改善，但尚不清楚联合用药是否有益。讨论：隐球菌性脑膜炎的标准治疗是阿替霉素B加或不加氟胞嘧啶。氟康唑是一种替代疗法，但其疗效尚未在未感染HIV的患者人群中记录。从理论上讲，阿替霉素B和氟康唑联合使用具有拮抗作用，但体外和体内数据表明可能不会发生拮抗作用。在隐球菌性脑膜炎中联合使用阿替霉素B和氟康唑尚未在临床试验中进行评估，不推荐使用。结论：1例隐球菌性脑膜炎患者因对阿替霉素B单药治疗反应差和对氟胞嘧啶不耐受而接受阿替霉素B和氟康唑联合治疗。目前尚不清楚她的临床反应是否是联合用药的结果。
OBJECTIVE: To describe a patient with cryptococcal meningitis treated with the combination of amphotericin B and fluconazole. CASE SUMMARY: A 41-year-old woman with cryptococcal meningitis who was not infected with HIV was treated with a combination of amphotericin B and fluconazole because she did not respond to amphotericin B alone and could not tolerate amphotericin B with flucytosine. She improved clinically, but it is unclear whether the combination was beneficial. DISCUSSION: Standard therapy for cryptococcal meningitis is amphotericin B with or without flucytosine. Fluconazole is an alternative therapy, but its efficacy has not been documented in the patient population not infected with HIV. Theoretically, the combination of amphotericin B and fluconazole is antagonistic, but in vitro and in vivo data suggest that antagonism may not occur. The combination of amphotericin B and fluconazole in cryptococcal meningitis has not been evaluated in clinical trials, and its use is not recommended. CONCLUSIONS: A patient with cryptococcal meningitis was treated with the combination of amphotericin B and fluconazole because of a poor response to amphotericin B monotherapy and intolerance to flucytosine. It is unclear whether her clinical response was a result of the combination.