阿莫罗芬搽剂联合口服伊曲康唑治疗甲真菌病疗效观察

目的探讨外用阿莫罗芬联合口服伊曲康唑治疗甲真菌病的疗效和安全性。方法将56例甲真菌病患者分成联合组(34例)、对照组(22例)观察两种治疗方法的疗效。结果停药2月后,联合治疗组有效率为97.06%;对照组72.73%(P<0.05)。结论阿莫罗芬搽剂联合口服伊曲康唑治疗甲真菌病能够增强疗效,治愈率高。     

阿莫罗芬联合伊曲康唑治疗甲真菌病的临床观察

目的 :观察阿莫罗芬联合伊曲康唑治疗甲真菌病的临床疗效和安全性。方法:将100例甲真菌病患者随机均分为对照组和联合用药组。对照组患者给予伊曲康唑胶囊200 mg,bid,餐中或餐后立即服用,连服7 d,停药3周,为1个疗程;指甲真菌病患者连用2个疗程,趾甲真菌病患者连用3个疗程。联合用药组患者在对照组治疗的基础上加用5%盐酸阿莫罗芬搽剂,局部外用,每周1次。两组患者疗程均为3个月。观察两组患者的临床疗效、真菌转阴率及不良反应发生情况。结果:联合用药组患者总有效率、转阴率均显著高于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:阿莫罗芬联合伊曲康唑治疗甲真菌病较单用伊曲康唑疗效更显著,安全性相当。     

基层医院药师参与治疗甲真菌病的临床研究

目的对比口服伊曲康唑联合包封修整术与单独水杨酸软膏包封修整术治疗甲真菌病的疗效。方法治疗组100例,每天口服伊曲康唑2次,每次200mg,连服7d为1个疗程,停药21d,指甲真菌病患者服用3个疗程,趾甲真菌病患者服用4个疗程同时联合水杨酸软膏封包清除病甲治疗;对照组40例单纯水杨酸软膏封包甲床修整,每周1次,每次封包保持3~4d,拆除包封后对病甲进行一次削整,重复5～1 0次。结果两组痊愈率比较(χ2=15.12,P<0.025),有效率比较(χ2=8.32,P<0.05),差异均具有统计学意义。结论口服伊曲康唑联合包封修整术治疗甲真菌病疗效明显优于单独病甲包封修整术治疗甲真菌病。     

伊曲康唑与特比萘芬治疗甲真菌病的研究

目的比较伊曲康唑与特比萘芬治疗甲真菌病的临床疗效。方法取220例甲真菌病患者,随机分为2组,一组给予特比萘芬0.25g,qd,指甲真菌病组连服6周,趾甲真菌病或指甲真菌病合并趾甲真菌病组连服12周。另一组给予伊曲康唑0.2g,bid,连服1周,停药3周为1个冲击疗程,指甲真菌病组连服2个冲击疗程,趾甲真菌病或指甲真菌病合并趾甲真菌病组连服3个冲击疗程。结果指甲真菌病痊愈率和愈显率特比萘芬组为87.0%和95.7%,伊曲康唑组为73.9%和78.3%。趾甲真菌病或指甲真菌病合并趾甲真菌病痊愈率和愈显率特比萘芬组为87.5%和95.3%,伊曲康唑组为75.0%和82.8%。结论特比萘芬治疗甲真菌病疗效优于伊曲康唑(P<0.05)。     

伊曲康唑冲击疗法治疗甲真菌病的疗效及对肝肾功能的影响

目的观察伊曲康唑冲击疗法治疗甲真菌病的临床疗效及对肝肾功能的影响。方法 145例甲真菌病患者中,指甲真菌病40例,趾甲真菌病78例,指趾甲真菌病27例。均予伊曲康唑治疗,指甲真菌病患者用药2个疗程,每月复诊1次,观察6个月;趾甲真菌病及指趾甲真菌病患者用药3个疗程,每2个月复诊1次,观察10个月。观察其疗效及对肝肾功能的影响。结果 67例（40例单纯指甲真菌病＋27例指趾甲真菌病）指甲真菌病患者治疗6个月后总有效率为95.5%。105例（78例单纯趾甲真菌病＋27例指趾甲真菌病）趾甲真菌病患者治疗10个月后总有效率为93.3%。肝肾功能检查结果显示患者服用伊曲康唑后各指标均在正常值范围内,差异无统计学意义（P〉0.05）。结论伊曲康唑冲击疗法治疗甲真菌病疗效高、疗程短、不良反应小,值得临床推广应用。     

伊曲康唑治疗甲真菌病的疗效观察

目的对甲真菌病应用伊曲康唑间歇冲击疗法进行疗效观察。方法甲真菌病患者65例,给予伊曲康唑200mg,口服,1次／d,连服7d,停药21d,1个月为1疗程,指甲真菌患者用2个疗程,趾甲或趾、指甲真菌患者连用3个疗程。结果指、趾甲真菌病有效率分别为97．1％．和90．0％,不良反应发生率6．1％。结论伊曲康唑间歇冲击疗法治疗真菌病疗效安全可靠,副作用小。     

伊曲康唑间歇冲击疗法治疗甲真菌病56例疗效观察

目的观察伊曲康唑间歇冲击疗法对甲真茵病的疗效。方法56例甲真菌病门诊病人,每日口服伊曲康唑400mg,分早晚两次．连续7d,停药21d为一疗程。指甲真菌病连续2个疗程,趾甲真菌病连续3个疗效。结果临床痊愈率为87．5%,有效率为92．9％,不良反应发生率为5．4％。结论伊曲康唑有良好的后效应,安全性好。     

伊曲康唑治疗甲真菌病两种疗法的比较

目的　了解伊曲康唑两种不同服药方法对甲真菌病的疗效。方法　甲真菌病人随机分为两组。间歇冲击疗法组( 4 0 0mg/d分两次服 ,服 1周停 3周为 1疗程 ,指甲真菌病服 2～ 3个疗程。趾甲和指甲共患甲真菌病服药 3～ 4个疗程 )和延时疗法组 (比间歇冲击疗法组剂量减半 ,疗程延长一倍 )。结果　服药 9周、12周、2 4周时两种疗法有效率明显不同P <0 0 5。服药 3 6周时两组有效率分别为 90 %和 86% ,无明显差异P >0 0 5。结论　伊曲康唑对甲真菌病疗效肯定 ,治愈率高 ,复发率低。两种服药方法切实可行 ,针对临床患者个体情况可选择不同服药方法     

伊曲康唑治疗甲真菌病临床观察

目的：观察伊曲康唑治疗甲真菌病临床疗效。方法：220例甲真菌病患者分为斯皮仁诺、美扶两组．每天服药两次,每次200mg连服7d,停药21d为一个疗程。指甲真菌病用药2个疗程,趾甲真菌病及指趾甲真菌病用药3个疗程。结果：两组指甲真菌病及趾甲真菌病临床痊愈率均约90％。结论：斯皮仁诺、美扶治疗指甲真菌病及指趾甲同患真菌病疗效差异无统计学意义。     

伊曲康唑治疗甲真菌病60例临床观察

目的观察伊曲康唑治疗甲真菌病的疗效。方法60例甲真菌病均用伊曲康唑胶囊(商品名:斯皮仁诺)口服,每次200毫克,一日2次,连用一周后停药三周为一疗程。手指甲真菌病为二疗程,足趾甲真菌病为三疗程。结果60例甲真菌病患者,停药后三个月,治愈57例,有效3例。痊愈率95%,总有效率100%,真菌学治愈率100%。结论伊曲康唑为三唑类广谱高效的抗真菌药,且副作用少而轻,是一种安全有效的药物。     

Onychomycosis in the elderly

Onychomycosis is found more frequently in the elderly, and in more males than females. Onychomycosis of the toes is usually caused by dermatophytes, most commonly Trichophyton rubrum and T. mentagrophytes. The most common clinical presentations are distal and lateral subungual onychomycosis (which usually affects the great/first toe) and white superficial onychomycosis (which generally involves the third/fourth toes). Only about 50% of all abnormal-appearing nails are due to onychomycosis. In the remainder, trauma to the nail, psoriasis and conditions such as lichen planus should be considered in the differential diagnosis. Therefore, the clinical impression of onychomycosis should be confirmed by mycological examination, whenever possible. The management of onychomycosis may include no therapy, palliative treatment with mechanical or chemical debridement, topical antifungal therapy, oral antifungal agents or a combination of treatment modalities. In the US, the only new oral agents approved for treatment of onychomycosis are terbinafine and itraconazole. Fluconazole is approved for onychomycosis in some other countries. Ciclopirox nail lacquer has recently been approved in the US for the treatment of onychomycosis. In some other countries topical agents such as amorolfine are also used. Griseofulvin and ketoconazole are no longer preferred for the treatment of onychomycosis. The new oral antifungal agents are effective and well tolerated in the elderly. Patient selection should be based on the history (including systems review and medication record), examination and baseline monitoring, if indicated. Laboratory monitoring during therapy for onychomycosis varies among physicians. A combination of removal of the diseased nail plate or local measures and oral antifungal therapy may be optimal in certain instances, e.g. when lateral onychomycosis or dermatophytoma are present. For dermatophyte toe onychomycosis the recommended duration of therapy with terbinafine is 250 mg/day for 12 weeks. For itraconazole (pulse) the regimen is 200 mg twice daily for 1 week on, 3 weeks off, repeated for 3 consecutive pulses and with fluconazole the regimen is 150 to 300 mg once weekly given for a usual range of 6 to 12 months or until the nail plate has grown out. In some instances, if extra therapy is required, one suggestion is that 4 weeks of terbinafine or an extra pulse of itraconazole are given between months 6 and 9 from the start of therapy. Once cure has been achieved, it is important to counsel patients on the strategies of reducing recurrence of disease.     

Clinical and economic factors in the treatment of onychomycosis

Onychomycosis is a fungal infection of fingernails and toenails, most cases of which are caused by dermatophytes. The disease accounts for 15% of all nail disease, and affects approximately 2 to 3% of people of all ages and both sexes. Topical treatment with tioconazole, amorolfine or ciclopirox has limited effectiveness. Oral griseofulvin 500 to 1000mg daily has been the mainstay of treatment, but prolonged therapy is required and success rates are low. Therapy with itraconazole 200mg daily for 3 to 6 months is more effective (70 to 85% success), although so-called 'pulse' therapy has shown similar success with potentially fewer adverse effects. Terbinafine 250mg daily produces clinical and mycological cure in approximately 80% of patients treated for 6 and 12 weeks for fingernail and toenail infections, respectively. The overall costs of treating onychomycosis are substantial, and it has been estimated that direct costs for Medicare patients with the disease were $US43 million in 1 year. In addition, the disease has a negative impact on quality of life, in the domains of mental functioning, health concern, social functioning, and physical appearance. Few pharmacoeconomic analyses have been published, but all have indicated an advantage of oral terbinafine over griseofulvin and other oral agents. To date, no economic studies have been performed on topical agents, pulse therapy or combination treatments.     

伊曲康唑间隙冲击疗法治疗甲真菌病120例

目的观察国产伊曲康唑（易启康）冲击疗法治疗甲真菌病的临床疗效,寻求有效而经济的治疗手段。方法120例甲真菌病患者每天口服易启康2次,每次200mg,连用7d,停药21d为1个疗程。指甲真菌病患者用药2个疗程,趾甲真菌病及指趾甲真菌病伴皮肤感染真菌病患者用药3个疗程,分别观察临床疗效和不良反应情况。结果52例指甲真菌病患者临床痊愈率为90．38％,68例趾甲真菌病及指趾甲真菌病伴皮肤感染真菌病患者临床痊愈率为83．82％,伴皮肤真菌感染者真菌清除率分别为96％和95％,不良反应发生率为4．17％。结论易启康短期冲击疗法治疗甲真菌病疗程短、疗效高、副作用小、安全性高而费用低,值得临床推广使用。     

Onychomycosis in the elderly : drug treatment options

The prevalence of onychomycosis is nearly 20% in patients aged >60 years. In North America, 90% of toenail onychomycosis is caused by dermatophytes (Trichophyton species). Distal-lateral subungual onychomycosis is the most common clinical presentation. The potassium hydroxide test is the most cost-effective diagnostic method. Although nail clipping for histology using periodic acid-Schiff stain is more sensitive, it is much more expensive.Elderly patients have specific risk factors for poor response to therapy for onychomycosis, including frequent nail dystrophy, slow growth of nails and increased prevalence of peripheral vascular disease and diabetes mellitus. Elderly people with diabetes should be treated for onychomycosis to prevent secondary bacterial infections and subsequent complications. Terbinafine is the drug of choice for dermatophyte onychomycosis, with greater mycological cure rates, less serious and fewer drug interactions, and a lower cost than continuous itraconazole therapy. Adjunct debridement may improve the clinical and complete cure rates compared with terbinafine alone. Common adverse effects of terbinafine in the elderly include nausea, sinusitis, arthralgia and hypercholesterolaemia. For onychomycosis caused by Candida or nondermatophyte moulds, there is no superior systemic therapy. In general, topical nail lacquers, amorolfine and ciclopirox are not practical for elderly patients because of the recommended frequency of application, periodic routine debridement of affected nails and long duration of therapy. However, nail lacquers may be a good option as monotherapy for patients with superficial white onychomycosis or in combination with systemic antifungal therapy for patients with predisposing factors for poor response or recurrence.     

Common fungal infections of the feet in patients with diabetes mellitus

Superficial fungal infections of the foot (tinea pedis and onychomycosis) are common among elderly patients. Although most authorities believe that patients with diabetes mellitus have an increased predisposition to dermatophytic infections, some controversies still remain. Because these infections disrupt the skin integrity and provide an avenue for bacterial superinfection, elderly diabetic patients with dermatophytic infection should be promptly treated with an antifungal agent. For most dermatophytic infections of the foot, topical agents are usually effective and less expensive than oral agents. Laboratory diagnosis of fungal infection prior to institution of therapy is recommended. Proper technique for obtaining the specimen is important to ensure a higher chance of isolating the infecting fungus. Commonly used anti-dermatophytic agents that are also active against the yeasts include the imidazoles, the allylamines-benzylamines and the hydroxypyridones, which are also effective against most of the moulds. Oral therapy for tinea pedis, although not well studied, should be limited to patients with more extensive infections, such as vesicobullous and moccasin type, resistant infections or chronic infections. In addition, oral agents should also be considered in diabetic and immunosuppressed patients. On the other hand, treatment of onychomycosis of the foot usually requires systemic therapy. Griseofulvin is the least effective agent when compared with the newer agents. Terbinafine, itraconazole and fluconazole have been shown to have acceptable cure rates. More recently, topical treatment of the nail with 8% ciclopirox nail lacquer, bifonazole with urea and amorolfine have been reported to be successful. Over the past decade, fungal foot infections of the skin and nail are more effectively treated with the introduction of numerous topical and oral agents.     

伊曲康唑注射液治疗深部真菌感染

目的:评价伊曲康唑注射液治疗深部真菌感染的有效性和安全性.方法:采用开放性临床研究,治疗深部真菌感染患者22例.确诊4例、拟诊10例、经验性治疗8例.剂量用法:d1～d2,伊曲康唑注射液200mg,iv,bid;d3～d14,200mg,iv,qd;d15～d42,改用伊曲康唑胶囊200mg,bid.结果:确诊和拟诊的14例患者真菌清除率为6/14,阴转率为6/14;综合疗效评价有效率为8/14,痊愈率为2/14.不良反应发生率为12/28.结论:伊曲康唑注射液治疗重症深部真菌感染安全有效.     

Onychomycosis in children: an overview

Onychomycosis in children is relatively uncommon, with a prevalence of approximately 0.3% worldwide. The most common etiologic organism in Trichophyton rubrum. The oral antifungal agents terbinafine, itraconazole, and fluconazole, and the topical nail lacquers ciclopirox and amorolfine, are not approved for use in treating onychomycosis in children. However, these agents appear to be effective and safe in this indication.     

Pharmacokinetics of antifungal agents in onychomycoses

Onychomycosis is caused by infection by fungi, mainly dermatophytes and nondermatophyte yeasts or moulds; it affects the fingernails and, more frequently, the toenails. Dermatophytes are responsible for about 90 to 95% of fungal infections. Trichophyton rubrum is the most common dermatophyte; Candida albicans is the major nondermatophyte yeast. Although topical therapy of onchomycosis does not lead to systemic adverse effects or interactions with concomitantly taken drugs, it does not provide high cure rates and requires complete compliance from the patient. At present there are 3 oral antifungal medications that are generally used for the short term treatment of onychomycosis: itraconazole, terbinafine and fluconazole. The persistence of these active drugs in nails allows weekly administration, reduced treatment or a pulse regimen. Good clinical and mycological efficacies are obtained with itraconazole 100 to 200 mg daily, terbinafine 250mg daily for 3 months, or fluconazole 150 mg weekly for at least 6 months. Itraconazole is a synthetic triazole with a broad spectrum of action. It is well absorbed when administered orally and can be detected in nails 1 to 2 weeks after the start of therapy. The nail : plasma ratio stabilises at around 1 by week 18 of treatment. Itraconazole is still detectable in nails 27 weeks after stopping administration. Nail concentrations are higher than the minimum inhibitory concentration (MIC) for most dermatophytes and Candida species from the first month of treatment. The elimination half-life of itraconazole from nails is long, ranging from 32 to 147 days. Terbinafine is a synthetic allylamine that is effective against dermatophytes. Terbinafine is well absorbed from the gastrointestinal tract, and the time to reach effective concentrations in nail is 1 to 2 weeks. The half-life is from 24 to 156 days, explaining the observed persistence of terbinafine in nails for longer than 252 days. Fluconazole is a bis-triazole broad spectrum antifungal with high oral bioavailability. The uptake of fluconazole by nail increases with the length of treatment, and nail : plasma ratios are generally 1.5 to 2 at steady state. Fluconazole concentrations exceed the MIC for Candida species soon after the start of treatment. Fluconazole concentrations fall slowly after the drug is stopped, with a half-life of 50 to 87 days, and fluconazole is still detectable in nails 5 months after the end of treatment. All these drugs are potent inhibitors of cytochrome P450 (CYP) enzymes and may increase the plasma concentrations of concomitantly used drugs. Itraconazole inhibits CYP3A4. Fluconazole inhibits CYP3A4, but to a lesser degree than itraconazole, CYP2C9 and CYP2C19. Terbinafine inhibits CYP2D6.     

伊曲康唑治疗念珠菌性阴道炎40例疗效观察

目的: 评价伊曲康唑对念珠菌性阴道炎的疗效.方法: 80例念珠菌阴道炎患者,随机分为2组,治疗组40例,用伊曲康唑200 mg,po,bid×1 d,对照组40例,用氟康唑150 mg 顿服,并进行临床及真菌学疗效观察.结果: 治疗组临床总有效率90.0%,对照组总有效率87.5%,差异无显著性(P>0.05).治疗组与对照组的真菌清除率分别为90.0%和85.0%,差异无显著性(P>0.05).结论: 伊曲康唑一日疗法可治愈绝大部分念珠菌阴道炎病人.     

三种治疗甲真菌病药物的成本——效果分析

目的：探讨3种抗真菌药（伊曲康唑、特比奈芬、氟康唑）治疗甲真菌病的经济效果,找出既经济又有效的治疗方案。方法：根据文献选择3种不同的治疗方案（伊曲康唑组、特比奈芬组、氟康唑组）,应用药物经济学成本-效果分析法。结果：治疗指甲真菌病所需药品成本分别是666.68,634.42,459.96元;治疗趾甲真菌病所需的药品成本分别是1000.02,911.98,689.94元。远期治愈率指甲真菌病分别是94.4%,100.0%和77.8%;趾甲真菌病分别是86.4%,95.2%和68.2%。结论：根据药物经济学成本-效果分析,特比奈芬是治疗甲真菌病的最佳药物。