echinocandins。
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Cappelletty D, Eiselstein-McKitrick K
echinocandins。
药物治疗。2007年3月,27 (3):369 - 88。
- PubMed ID
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17316149 (在PubMed]
- 文摘
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真菌感染的变化模式驱动需要扩大抗真菌活性的目标。echinocandins是最新的阿森纳对真菌感染。三个echinocandins已经批准美国食品和药物管理局:caspofungin micafungin, anidulafungin。这些代理有一个广泛的活动,类似于彼此对体外对假丝酵母sp活动,与micafungin anidulafungin拥有类似的最小抑制浓度(麦克风),通常低于capsofungin的麦克风。中等收入国家对念珠菌parapsilosis echinocandins最高;但是,这是否会影响临床结果是未知的。几个案例报告列出了临床失败由于caspofungin高架麦克风或micafungin对白色念珠菌、念珠菌krusei, c . parapsilosis。抵抗echinocandin类存在于一些但不是全部隔离。经验治疗的echinocandins candidemia或嗜中性白血球减少症患者侵袭性念珠菌病和那些没有嗜中性白血球减少症似乎是适当的死亡率,当一个因素的增加频率non-albicans念珠菌感染,广谱,安全和echinocandins的抑菌效果。生物物种形成后,继续治疗echinocandin可以而且应该重新评估。 The echinocandins demonstrate similar in vitro and in vivo activity against Aspergillus sp, but only caspofungin is approved for treatment in patients who are intolerant of or refractory to other therapies. Voriconazole and amphotericin B have demonstrated synergy with the echinocandins. The clinical response to combination therapy has been variable; however, the mortality rate appears to be lower with combination therapy than monotherapy. Large controlled trials are needed to determine the role of combination therapy for invasive aspergillosis. Micafungin and anidulafungin generally have a lower frequency of adverse reactions compared with caspofungin. Phlebitis (3.5-25% of patients) and elevated liver enzyme levels (1-15%) occur more often with caspofungin compared with micafungin and anidulafungin (< 8%). Overall, the three echinocandins are relatively safe and effective agents for the treatment of Candida infections.
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