TREATMENT OF INVASIVE ASPERGILLOSIS WITH ITRACONAZOLE
TREATMENT OF INVASIVE ASPERGILLOSIS WITH ITRACONAZOLE
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DOI：
10.1016/0002-9343(89)90475-0
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发表时间：
1989-06-01
影响因子：
5.9
通讯作者：
STEVENS, DA
中科院分区：
文献类型：
--
作者：
DENNING, DW;TUCKER, RM;STEVENS, DA
侵袭性曲霉病是免疫功能低下的宿主中最难治疗的问题之一。伊曲康唑是一种新型口服三唑类化合物，在体外对曲霉菌具有抑菌和杀菌作用。在动物模型中，它对曲霉感染有积极的作用。我们报告了21例曲霉病患者使用伊曲康唑治疗的经验。21名患者中有18名患者每天服用400毫克伊曲康唑；另外3名患者每天服用100-200毫克。测定伊曲康唑的血药浓度，并按上述方法进行药敏试验。在15例可评价的患者中，有12例有效。5例侵袭性肺部疾病中4例有效，2例骨骼疾病中2例有效，2例胸膜疾病中1例有效，1例心包、鼻窦、乳突或肝脾曲菌病有效，1例甲真菌病有效。一名颈动脉疾病患者没有表现出反应，尽管尸检的培养结果为阴性。一名患有关节疾病的应答者在完成12个月的治疗后三个月可能复发。其中10名患者免疫功能低下(包括4名中性粒细胞减少症患者和2名肾移植受者)，其中8名患者有反应。与以前的治疗方法相比，伊曲康唑的副作用很少。这一经验表明，伊曲康唑可能是曲霉菌病治疗的重要进展。
Invasive aspergillosis in the immunocompromised host is one of the most difficult therapeutic problems. Itraconazole, a new oral triazole, is inhibitory as well as fungicidal against Aspergillus species in vitro. It is active against Aspergillus infections in animal models. We present our experience with itraconazole therapy of 21 patients with aspergillosis. Eighteen of the 21 patients received 400 mg of itraconazole orally per day; the other three received 100 to 200 mg daily. Serum concentrations of itraconazole were measured and susceptibility testing was performed according to previously described methods. Of 15 evaluable patients, responses were produced in 12. Four of five with invasive pulmonary disease, two of two with skeletal disease, one of two with pleural disease, one of one with pericardial, sinus, mastoid, or hepatosplenic aspergillosis, and one of one with onychomycosis responded. One patient with carotid artery disease did not show a response, although results of cultures were negative at autopsy. One responder with joint disease had a possible relapse three months after completing 12 months of therapy. Ten of these patients were immunocompromised (including four with neutropenia and two renal transplant recipients) and eight of these responded. Side effects with itraconazole, in contrast to previously available therapy, were rare. This experience suggests itraconazole may be an important advance in the therapy of aspergillosis.