FLUCONAZOLE THERAPY FOR COCCIDIOIDAL MENINGITIS
FLUCONAZOLE THERAPY FOR COCCIDIOIDAL MENINGITIS
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DOI：
10.7326/0003-4819-119-1-199307010-00005
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发表时间：
1993-07-01
影响因子：
39.2
通讯作者：
GRAYBILL, JR
中科院分区：
文献类型：
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作者：
GALGIANI, JN;CATANZARO, A;GRAYBILL, JR
目标：确定氟康唑治疗球孢子菌性脑膜炎的有效性和安全性。设计：非对照临床试验。设置：加州，亚利桑那州和得克萨斯州的四所大学为基础的治疗中心。大多数治疗是在没有住院的情况下进行的。患者：连续50例活动性球孢子菌脑膜炎患者，其中47例（94%）是可评价的。25例患者没有接受过治疗，他们的脑膜炎和9人合并感染人类免疫缺陷病毒（HIV）。干预：氟康唑口服剂量为400毫克，每天一次，长达4年（中位数，37个月）的响应患者。同时治疗与另一种抗真菌剂是abandoned. Measures：预定义的评估感染相关的异常是在登记的时候，并重复至少每4个月在治疗期间。消除40%或以上的基线异常被视为缓解。结果：47例可评估患者中有37例（79%; 95%CI，61%至90%）对治疗有反应。既往接受过治疗和未接受过治疗的患者、合并HIV感染和未合并HIV感染的患者以及既存脑积水和无脑积水的患者的缓解率相似。大多数改善发生在开始治疗后4至8个月内。患者症状比脑脊液异常更快地消退。在20例随访20个月或更长时间的应答患者中，有15例在整个治疗过程中仍然存在残留的低水平脑脊液异常。没有病人停止治疗，因为药物相关的副作用，虽然混乱的两名患者，解决时，氟康唑的剂量reduced.Conclusion：氟康唑治疗往往是有效的抑制球孢子菌脑膜炎。
Objective: To determine the efficacy and safety of fluconazole treatment of coccidioidal meningitis.Design: Uncontrolled clinical trial.Setting: Four university-based treatment centers in California, Arizona, and Texas. Most therapy was conducted without hospitalization.Patients: Fifty consecutive patients with active coccidioidal meningitis, of which 47 (94%) were evaluable. Twenty-five patients had received no previous treatment for their meningitis and nine had coinfection with human immunodeficiency virus (HIV).Intervention: Fluconazole was administered in an oral dose of 400 mg once per day for up to 4 years (median, 37 months) in responding patients. Concurrent therapy with another antifungal agent was prohibited.Measurements: Predefined assessment of infection-related abnormalities was done at the time of enrollment and was repeated at least every 4 months during treatment. Elimination of 40% or more of baseline abnormalities was considered a response.Results: Thirty-seven of 47 (79%; 95% CI, 61% to 90%) evaluable patients responded to treatment. Response rates were similar for patients with and without previous therapy, for patients with and without concomitant HIV infection, and for patients with and without pre-existing hydrocephalus. Most improvement occurred within 4 to 8 months after starting treatment. Patient symptoms resolved more quickly than did cerebrospinal fluid abnormalities. In 15 of 20 responding patients followed for 20 months or more, residual low-level cerebrospinal fluid abnormalities remained throughout therapy. No patient discontinued therapy because of drug-related side effects, although confusion developed in two patients that resolved when the dose of fluconazole was reduced.Conclusion: Fluconazole therapy is often effective in suppressing coccidioidal meningitis.