3种抗真菌药治疗甲真菌病疗效对比观察

应用伊曲康唑、特比萘芬、氟康唑３种不同抗真菌药物治疗１２０例甲真菌病患者,并作疗效对比观察,结果显示,３种药物均有较艰的抗真菌疗效,特比萘芬疗效优于伊曲康唑及氟康唑,伊曲康唑疗效优于所经康唑。３种药物近、中、远期临床治愈率及真菌学阴转率,复发率Ｐ值均〉０．０５,无统计学意义。     

61株甲源性近平滑念珠菌药敏试验报告

根据美国国家临床实验室标准化委员会M27-A微量稀释法对近平滑念珠菌作了伊曲康唑、特比萘芬和氟康唑3种抗真菌药物敏感性测定。结果:伊曲康唑、特比萘芬、氟康唑对61株近平滑念珠菌的平均MIC值分别为:3.20μg/mL、0.42μg/mL、2.33μg/mL。体外特比萘芬对近平滑念珠菌敏感性高于伊曲康唑和氟康唑。     

伊曲康唑治疗头癣效果的系统评价

检索了Cochrane Library，Medline，EMBASE，中国生物医学数据库，手检《中华皮肤科杂志》，《临床皮肤科杂志》，《中国麻风皮肤病杂志》，《中国皮肤性病学杂志》，检索的最近日期至2003年12月。比较伊曲康唑与其他抗真菌药治疗头癣的效果和安全性。最终3个随机对照试验完全符合本系统评价的纳入标准，对照措施包括灰黄霉素，特比萘芬，氟康唑。纳入研究的样本含量从35例到200例。结论：伊曲康唑治疗头癣效果与灰黄霉素，特比萘芬，氟康唑相当，且副作用小于灰黄霉素。     

51株甲真菌病白念珠菌体外药物敏感性试验

参照美国国家临床实验室标准化委员会M27-A棋盘微量稀释法,检测了分离自2005年1月至2007年10月,于北京大学第三医院第二门诊部就诊的甲真菌病患者的51株白念珠菌对伊曲康唑、特比萘芬和氟康唑3种抗真菌药物的体外敏感性.伊曲康唑、特比萘芬、氟康唑对51株甲源性白念珠菌的平均最小抑菌浓度(MIC)分别为:0.23 μg/mL、3.84 μg/mL、6.52 μg/mL.伊曲康唑在体外对白念珠菌敏感性高于特比萘芬和氟康唑.     

伊曲康唑和特比萘芬治疗甲癣的优与劣

对最新二种亲脂性、口服抗真菌药伊曲康唑和特比萘芬在治疗甲癣上进行了探讨。从甲癣的临床与甲癣致病菌的变迁过论治疗甲癣理想抗真菌药的条件。伊曲康唑和特比萘芬药代动力学与在甲的药代动力学，伊曲康唑和特比萘芬治疗甲癣的疗效，以及对其疗效的比较，不良反应的发生率，最后介绍了甲癣短程间歇冲击疗法。     

特比萘芬与氟康唑或伊曲康唑联合治疗系统性耐药性白念珠菌感染小鼠模型研究

目的研究特比萘芬与氟康唑或伊曲康唑联合治疗系统性耐药性白念珠菌病的疗效。方法建立小鼠系统性白念珠菌感染模型,应用特比萘芬与氟康唑或伊曲康唑联合治疗系统性白念珠菌感染。结果联合用药组小鼠的存活时间比单用药组明显延长(P<0.05),肾组织真菌计数显示联合治疗组明显低于单用药组(P<0.05)。结论特比萘芬与氟康唑或伊曲康唑联合疗法可增强抗白念珠菌效能,具有临床应用的潜能。     

三种抗真菌药物对糖尿病大鼠TLRs和Th细胞因子水平的影响

目的: 测定氟康唑,伊曲康唑和特比萘芬对糖尿病大鼠Toll样受体(TLRs)和辅助性T细胞(Th细胞)细胞因子水平的影响.方法: 建立鼠糖尿病模型,喂食氟康唑,伊曲康唑和特比萘芬4周后,流式细胞术对糖尿病大鼠脾脏T细胞TLR2、TLR4、IFN-γ和IL-4水平进行检测;实时荧光定量PCR (Real-Time PCR)检测TLR4在脾脏细胞中的表达.结果: 氟康唑、伊曲康唑和特比萘芬可以提高糖尿病大鼠TLR2与TLR4的表达水平;伊曲康唑还可提高糖尿病大鼠Th1型免疫应答.结论: 3种抗真菌药物可以通过激发宿主对真菌的天然和获得性免疫应答促进机体对真菌的抵御.     

883例甲真菌病治疗后复发或再感染情况观察

自从伊曲康唑、氟康唑、特比萘芬上市以来,甲真菌病的问题得到很大缓解,经近几年来的临床应用,疗效可靠.但对其远期效果和影响观察不多.我们于2001-2005年对口服抗真菌药治疗甲真菌病的部分患者进行回访,报道如下.     

《岭南皮肤性病科杂志》2003年第10卷总目次索引

真菌病卷 (期 )页2 %酮康唑制剂治疗小儿念珠菌皮炎 110例临床观察10 (1) :12国产特比奈芬治疗皮肤浅部真菌病的疗效观察 10 (1) :19伊曲康唑治疗儿童头癣 36例临床观察 10 (1) :2 6成人头部真菌病 2 6例临床分析 10 (2 ) :83特比奈芬与伊曲康唑治疗念珠菌性阴道炎疗效比较10 (2 ) :97伊曲康唑与达克宁栓联合治疗阴道念珠菌病 6 6 2例疗效观察 10 (2 ) :12 0裴氏着色真菌病 1例报告 10 (2 ) :12 6E test检测念珠菌对 5种抗真菌药物敏感性试验10 (3) :14 8伊曲康唑与环吡酮联合治疗严重甲真菌病疗效观察10 (3) :15 30 .2 5 %盐酸阿莫洛芬霜…     

伊曲康唑和特比萘芬治疗甲癣的优与劣

对最新二种亲脂性、口服抗真菌药伊曲康唑和特比萘芬在治疗甲癣上进行了探讨。从甲癣的临床与甲癣致病菌的变迁讨论治疗甲癣理想抗真菌药的条件。伊曲康唑和特比萘芬药代动力学与在甲的药代动力学,伊曲康唑和特比萘芬治疗甲癣的疗效,以及对其疗效的比较,不良反应的发生率,最后介绍了甲癣短程间歇冲击疗法。     

盐酸特比萘芬阴道泡藤片联合乳杆菌活菌治疗复发性外阴阴道假丝酵母菌病57例临床观察

目的观察盐酸特比萘芬阴道泡藤片联合乳杆菌活菌治疗复发性外阴阴道假丝酵母菌病(RVVC)的临床疗效。方法将164例RVVC患者随机分为3组,治疗组(57例)予盐酸特比萘芬阴道泡藤片联合乳杆菌活菌胶囊治疗,对照1组(50例)仅予盐酸特比萘芬阴道泡藤片治疗,对照2组(57例)仅予硝酸咪康唑阴道胶囊治疗。3组患者均随访1年。结果 1年后,治疗组、对照1组和对照2组有效率分别为89.47%,80.00%,73.68%,复发率分别为10.00%,25.64%和26.19%,3组的有效率和复发率比较,差异均有统计学意义(P均<0.05)。结论盐酸特比萘芬阴道泡藤片联合乳杆菌活菌治疗RVVC的疗效好,复发率低。     

A double-blind, randomized study to compare the efficacy and safety of terbinafine (Lamisil) with fluconazole (Diflucan) in the treatment of onychomycosis

In a randomized, double-blind, double-placebo, multicentre study, terbinafine 250 mg daily for 12 weeks was compared with fluconazole 150 mg once weekly for 12 or 24 weeks in the treatment of onychomycosis. A total of 137 patients with culture-confirmed onychomycosis was divided into three groups: group A received terbinafine for 12 weeks, group B received fluconazole for 12 weeks, while group C received fluconazole for 24 weeks. At completion of the study (week 60), the mycological cure rate was higher in the terbinafine group than in the fluconazole groups: 89% vs. 51% and 49%, respectively (P < 0.001). The length of unaffected nail increased until week 24 in group B and until week 36 in group C, but was still increasing in group A at the final visit (week 60). Complete clinical cure of the target nail at week 60 was 67% in the terbinafine group, compared with 21% and 32% in the fluconazole groups, respectively. The incidence of adverse events was low for both study agents. We conclude that terbinafine 250 mg daily for 12 weeks is significantly more effective in the treatment of onychomycosis than fluconazole 150 mg once weekly for either 12 or 24 weeks.     

Treatment of tinea imbricata: a randomized clinical trial using griseofulvin, terbinafine, itraconazole and fluconazole

BACKGROUND: Griseofulvin has been the mainstay of treatment for tinea imbricata (TI) for decades; however, there have been few reports of efficacy of newer antifungals in the treatment of this condition. Many patients with TI have several obstacles to treatment due to their remote geographical locations and the primitive nature of their societies. OBJECTIVES: The aim of this study was to compare the efficacy of itraconazole, terbinafine and fluconazole with that of griseofulvin after 4 weeks of therapy. METHODS: Patients aged 12-76 years with the clinical diagnosis of TI were randomly assigned to one of four treatment groups: griseofulvin 500 mg twice daily for 4 weeks, terbinafine 250 mg daily for 4 weeks, itraconazole 200 mg twice daily for 1 week or fluconazole 200 mg once weekly for 4 weeks. Disease activity was monitored weekly. Laboratory measurements included monitoring complete blood count and liver function enzymes. Fifty-nine patients were included in the efficacy analysis: 13 in the fluconazole group, 15 in the griseofulvin group, 12 in the terbinafine group and 19 in the itraconazole group. RESULTS: Significant remission was achieved in the terbinafine and griseofulvin groups, lasting up to 8 weeks after cessation of therapy. The fluconazole group experienced no significant remission, and remission was of short duration in the itraconazole group. No adverse events were reported, and non-compliance with medications or follow-up was the only reason for removal from the study. CONCLUSIONS: Griseofulvin and terbinafine are effective in the treatment of TI. The decision of whether to treat at all and which medication to choose depends greatly on the extent of involvement, the social situation, and the availability of resources such as laboratory testing and follow-up.     

Efficacy of itraconazole, terbinafine, fluconazole, griseofulvin and ketoconazole in the treatment of Scopulariopsis brevicaulis causing onychomycosis of the toes

BACKGROUND: Scopulariopsis brevicaulis is a common non-dermatophyte mould that can cause onychomycosis. OBJECTIVE: To evaluate the efficacy and safety of the oral antifungal agents griseofulvin, ketoconazole, itraconazole, fluconazole and terbinafine in the treatment of S. brevicaulis. PATIENTS AND METHODS: In a prospective, comparative, parallel-group, single-blinded, randomized, non-industry-sponsored study, patients with toe onychomycosis caused by S. brevicaulis sp. were randomized and treated with one of 5 oral antifungal agents, i.e. griseofulvin, ketoconazole, itraconazole (pulse), fluconazole or terbinafine. The treatment regimens were: griseofulvin 600 mg twice daily for 12 months, ketoconazole 200 mg daily for 4 months, itraconazole pulse therapy given for 3 pulses, with each pulse consisting of 200 mg twice daily for 1 week with 3 weeks off between successive pulses, terbinafine 250 mg daily for 12 weeks and fluconazole 150 mg daily for 12 weeks. RESULTS: There were 59 patients (48 males, 11 females, mean age 35.6 years, range 25-53 years). All patients had clinical evidence of distal and lateral onychomycosis, with moderate to severe disease of the target nail. Between the treatment groups there was no significant difference in the mean age of the patients or the mean area of involvement with onychomycosis at baseline. The efficacy parameters were clinical cure (CC) and mycological cure (MC). At month 12 after the start of treatment, the response was: griseofulvin, CC 3/11, MC 0/11, CC + MC 0/11; ketoconazole, CC 10/12, MC 8/12, CC + MC 8/12; itraconazole, CC 12/12, MC 12/12, CC + MC 12/12; terbinafine, CC 12/12, MC 11/12, CC + MC 11/12, and fluconazole, CC 8/12, MC 8/12, CC + MC 8/12. Adverse effects consisted of: griseofulvin, gastro-intestinal symptoms, allergic reaction, photodermatitis, hepatic and renal dysfunction in 11 patients with discontinuation of treatment in 3 patients; ketoconazole, hepatic dysfunction but no symptomatic changes in 2 patients; itraconazole, nausea and vomiting in 2 patients; terbinafine, taste disturbance in 2 patients, nausea in 3 patients, and fluconazole, severe gastro-intestinal events in 5 patients. None of the patients receiving ketoconazole, itraconazole, terbinafine or fluconazole discontinued treatment. CONCLUSIONS: Itraconazole and terbinafine demonstrate efficacy against some cases of S. brevicaulis toe onychomycosis. These agents also appear to be safe in the course of therapy for toe onychomycosis. Griseofulvin is ineffective against toe onychomycosis caused by S. brevicaulis. Ketoconazole is not recommended for toe onychomycosis given its potential for adverse effects, particularly with the availability of the newer antifungal agents.     

特比萘芬片口服联合特比萘芬凝胶外用治疗足癣疗效观察

目的探讨口服特比萘芬联合外用特比萘芬凝胶治疗足癣的疗效。方法将足癣患者124例随机分成两组,治疗组64例,口服特比萘芬1次/d,同时外用1%特比萘芬凝胶2次/d,疗程2周。对照组60例,局部外用1%特比萘芬凝胶2次/d,疗程4周。结果治疗组治愈率为96.9%,真菌清除率为90.6%;对照组分别为91.7%和86.7%。结论联合疗法和单一外用药物治疗足癣均有效,但联合疗法起效快、效果较好。     

氟康唑治疗孢子丝菌病的临床疗效及体外抗真菌药敏试验研究

目的观察氟康唑对孢子丝菌病的临床疗效,检测孢子丝菌对氟康唑、伊曲康唑的体外敏感性,探讨孢子丝菌病治疗的新方法。方法对60例孢子丝菌病患者给予氟康唑片口服治疗[成人首次100mg,以后50mg,儿童3～5mg/(kg.d)],30例患者给予10%碘化钾溶液10mL口服治疗,并采用E-test法检测其中10株孢子丝菌对氟康唑和伊曲康唑的最小抑菌浓度(MIC)。结果氟康唑组有效率为95.00%,碘化钾组为86.67%。采用E-test法检测10株孢子丝菌对氟康唑和伊曲康唑的MIC值,范围分别为>256μg/mL,0.012～8.0μg/mL。结论氟康唑对孢子丝菌病有较好的临床疗效,但申克氏孢子丝菌对对氟康唑的体外敏感性较低。E-test法可以作为一种孢子丝菌的体外抗真菌药敏试验方法。     

四种抗真菌药物治疗甲癣疗效比较的文献系统复习

目的比较特比萘芬与伊曲康唑、氟康唑、灰黄霉素治疗甲癣疗效的差异。方法检索Medline文献数据库,查找所有比较特比萘芬与伊曲康唑、氟康唑、灰黄霉素治疗甲癣的双盲随机对照试验的文献,找出这4种药物治疗甲癣的真菌学治愈率并对其进行汇总,得出合并后真菌学治愈率的比值比(OR)及其95%可信区间(CI)。结果①有6篇比较特比萘芬与伊曲康唑、1篇特比萘芬与氟康唑、2篇特比萘芬与灰黄霉素治疗甲癣的双盲随机对照试验文献被纳入。②特比萘芬250mg/d连续疗法优于伊曲康唑400mg/d冲击疗法[OR=5.01,95%CI(3.42～7.33)]和伊曲康唑200mg/d连续疗法[OR=2.58,95%CI(1.91～3.49)]。特比萘芬的疗效亦优于氟康唑(P<0.001)和灰黄霉素[OR=3.46,95%CI(1.89～6.31)]。结论特比萘芬治疗甲癣的疗效优于伊曲康唑、氟康唑和灰黄霉素。     

Therapeutic Options for the Treatment of Tinea Capitis Caused by Trichophyton Species: Griseofulvin Versus the New Oral Antifungal Agents, Terbinafine, Itraconazole, and Fluconazole

Tinea capitis is a relatively common fungal infection of childhood. Griseofulvin has been the mainstay of management. However, newer oral antifungal agents are being used more frequently. A multicenter, prospective, randomized, single-blinded, non-industry-sponsored study was conducted in centers in Canada and South Africa to determine the relative efficacy and safety of griseofulvin, terbinafine, itraconazole, and fluconazole in the treatment of tinea capitis caused by Trichophyton species. The regimens for treating tinea capitis were griseofulvin microsize 20 mg/kg/day x 6 weeks, terbinafine [> 40 kg, one 250 mg tablet; 20-40 kg, 125 mg (half of a 250 mg tablet); < 20 kg, 62.5 mg (one-quarter of a 250 mg tablet)] x 2-3 weeks, itraconazole 5 mg/kg/day x 2-3 weeks, and fluconazole 6 mg/kg/day x 2-3 weeks. Patients were asked to return at weeks 4, 8, and 12 from the start of the study. Griseofulvin was administered for 6 weeks and the final evaluation was at week 12. Terbinafine, itraconazole, and fluconazole were administered for 2 weeks and the patient evaluated 4 weeks from the start of therapy. At this time, if clinically indicated, one extra week of therapy was given. There were 200 patients randomized to four treatment groups (50 in each group). At the final evaluation at week 12, the number of evaluable patients were griseofulvin, 46; terbinafine, 48; itraconazole, 46; and fluconazole, 46. Patients who discontinued therapy or were lost to follow-up were griseofulvin, 1/3; itraconazole, 0/4; terbinafine, 0/4; and fluconazole, 0/4. The causative organisms were Trichophyton tonsurans and T. violaceum species. Patients were regarded as effectively treated at week 12 if there was mycologic cure and either clinical cure or only a few residual symptoms. Effective treatment was recorded in, intention to treat, griseofulvin (46 of 50, 92.0%), terbinafine (47 of 50, 94.0%), itraconazole (43 of 50, 86.0%), and fluconazole (42 of 50, 84.0%) (p=0.33). Adverse effects were reported only in the griseofulvin group (gastrointestinal effects in six patients). Discontinuation from therapy due to adverse effects occurred only in the griseofulvin group (nausea in one patient). For the treatment of tinea capitis caused by the Trichophyton species, in this study, griseofulvin given for 6 weeks is similar in efficacy to terbinafine, itraconazole, and fluconazole given for 2-3 weeks. Each of the agents has a favorable adverse-effects profile.     

Cumulative meta-analysis of systemic antifungal agents for the treatment of onychomycosis

BACKGROUND: Onychomycosis is a common nail disease that is often chronic, difficult to eradicate, and has a tendency to recur. The most common oral therapies for dermatophyte toenail onychomycosis include terbinafine, itraconazole and fluconazole. OBJECTIVES: A cumulative meta-analysis of the randomized controlled trials (RCTs) for antimycotic agents was performed to determine whether the pooled estimate of the cure rates has remained consistent over the years. Furthermore, for each agent we compared the overall meta-analytical average of both mycological and clinical response rates of RCTs vs. open studies. METHODS: We searched MEDLINE (1966 to November 2002) for relevant studies evaluating the efficacy of the oral antifungal agents terbinafine, itraconazole (pulse or continuous), fluconazole and griseofulvin for treating dermatophyte toenail onychomycosis. Studies included in this meta-analysis required a standard accepted dosage regimen, treatment duration and follow-up period. To determine the cumulative meta-analytical average, studies were sequentially pooled by adding one study at a time according to the date of publication (i.e. earliest to the most recent). RESULTS: There were 36 studies included in the analyses. For RCTs the change in efficacy of mycological cure rates from the first trial to the overall cumulative meta-average for each drug comparator is as follows (with 95% confidence interval): terbinafine, 78 +/- 6% (n = 2 studies, 79 patients) to 76 +/- 3% (n = 18 studies, 993 patients) (P = 0.68); itraconazole pulse, 75 +/- 10% (n = 1 study, 20 patients) to 63 +/- 7% (n = 6 studies, 318 patients) (P = 0.25); itraconazole continuous, 63 +/- 5% (n = 1 study, 84 patients) to 59 +/- 5% (n = 7 studies, 1131 patients) (P = 0.47); fluconazole, 53 +/- 6% (n = 1 study, 72 patients) to 48 +/- 5% (n = 3 studies, 131 patients) (P = 0.50); and griseofulvin, 55 +/- 8% (n = 2 studies, 109 patients) to 60 +/- 6% (n = 3 studies, 167 patients) (P = 0.41). The cumulative meta-analytical average of mycological cure rates when comparing RCTs vs. open studies was: terbinafine, 76 +/- 3% (n = 18 studies, 993 patients) vs. 83 +/- 12% (n = 2 studies, 391 patients) (P = 0.0028); itraconazole pulse, 63 +/- 7% (n = 6 studies, 318 patients) vs. 84 +/- 9% (n = 3 studies, 194 patients) (P = 0.0001); and fluconazole, 48 +/- 5% (n = 3 studies, 131 patients) vs. 79 +/- 3% (n = 3 studies, 208 patients) (P = 0.0001). CONCLUSIONS: The cumulative meta-analysis of cure rates for RCTs suggests that over time, as new RCTs have been conducted, the efficacy rates have remained consistent. The efficacy rates of open studies are substantially higher compared with RCTs and may therefore overestimate cure rates.     

Comparative evaluation of griseofulvin, terbinafine and fluconazole in the treatment of tinea capitis

Tinea capitis (TC) is a common childhood fungal infection which, if untreated, can cause long‐term scarring. A number of antifungal drugs with proven efficacy are available for the treatment of TC. However, varying dosage schedules, changes in epidemiology, and rising drug resistance are factors that hamper treatment in some cases. A prospective, non‐blinded, cross‐sectional study of three commonly used drugs (terbinafine, griseofulvin, and fluconazole) was undertaken in children aged ≤12 years, presenting to a pediatric superspecialty hospital. The comparative efficacies of these three drugs were evaluated. A total of 75 patients (25 in each treatment group) who completed the designated treatment protocol were included in the final analysis. Of these, 60% had non‐inflammatory TC and 56% had an ectothrix pattern on hair microscopy. Trichophyton violaceum was the most commonly isolated fungus. Cure rates of 96%, 88%, and 84% were achieved with griseofulvin, terbinafine, and fluconazole, respectively. Overall, seven patients required prolonged therapy. No side effects to therapy were seen. Griseofulvin remains the drug of choice in the treatment of TC. Terbinafine was the second best agent and offered the advantage of a shorter course of therapy. Fluconazole had comparatively low cure rates but was easier to administer than the other two medications.