Comparison of the efficacy of amphotericin B and fluconazole in the treatment of cryptococcosis in human immunodeficiency virus-negative patients: Retrospective analysis of 83 cases
Comparison of the efficacy of amphotericin B and fluconazole in the treatment of cryptococcosis in human immunodeficiency virus-negative patients: Retrospective analysis of 83 cases
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DOI：
10.1093/clinids/22.supplement_2.s154
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发表时间：
1996-05-01
影响因子：
11.8
通讯作者：
Letenneur, L
中科院分区：
文献类型：
--
作者：
Dromer, F;Mathoulin, S;Letenneur, L
我们回顾性分析了使用两性霉素B（43例）或氟康唑（40例）治疗的HIV阴性患者的脑膜和脑膜外隐球菌病的临床结局，两性霉素B和氟康唑同样适用于肿瘤性疾病和无危险因素的患者，但器官移植受者和其他疾病患者大多分别使用氟康唑和两性霉素B。感染较严重的患者（即，脑膜炎、神经系统疾病或脑脊液中抗原水平较高）更常使用阿替霉素B治疗。考克斯回归分析显示年龄>60岁、肿瘤性疾病、精神状态异常、诊断时播散性感染和治疗失败是死亡的独立预测因素。虽然氟康唑似乎与阿替霉素B一样有效，但只有一项前瞻性多中心研究才能确定未患艾滋病的隐球菌脑膜炎患者的最佳治疗方案。
We retrospectively analyzed clinical outcome of meningeal and extrameningeal cryptococcosis in HIV-negative patients treated with amphotericin B (43 patients) or fluconazole (40 patients), Amphotericin B and fluconazole were prescribed equally to patients with neoplastic diseases and no risk factor, but organ transplant recipients and patients with other diseases were mostly given fluconazole and amphotericin B, respectively. Patients with more severe infections (i.e., meningitis, neurological disorders, or higher levels of antigen in cerebrospinal fluid) were more frequently treated with amphotericin B. A cure rate of >70% was achieved regardless of the initial treatment and the severity of the infection, A Cox regression analysis showed that age of >60 years, neoplastic disease, abnormal mental status, disseminated infection at the time of diagnosis, and therapeutic failure were independent predictors of death. Although fluconazole appears to be as effective as amphotericin B, only a prospective multicenter study will determine the best treatment regimen for patients with cryptococcal meningitis who do not have AIDS.