氟康唑与伊曲康唑治疗甲癣的疗效比较

目的观察氟康唑与伊曲康唑治疗甲癣的疗效。方法 将352例甲癣患者根椐治疗药物不同分为氟康唑组169例和伊曲康唑183例。观察2组疗效及不良反应。结果 2组临床疗效比较差异无统计学意义（P〉0.05）;且不良反应均较轻微。结论 氟康唑与伊曲康唑治疗甲癣的疗效相近,但是氟康唑更经济,而氟康唑疗程较伊曲康唑长,临床应用各有优势。     

伊曲康唑致严重不良反应1例

1　病例介绍患者 ,女 ,45岁 ,因左眼角膜穿通伤缝合术后 ,复发眼红、眼痛 ,使用地塞米松磷酸钠 新霉素 (的确当 )眼药水后无缓解来我院就诊。体检 :视力Ｖｄ =1.0 ,Ｖｓ =ＦＣ 10ｃｍ ,左眼混合性充血、角膜内上方见一已缝合斜形伤口 ,其周围角膜浅层溃疡 ,表面粗糙 ,其后近角膜缘处见一小块脓疡 ,前房水混浊 ,下方可见一积脓液面 ,高约 0 .5ｍｍ。瞳孔散大 ,直径 6ｍｍ ,晶体透明 ,眼底透照欠清 ,眼压Ｔｎ。临床诊断 :左眼角膜穿通伤缝合术后 ,左眼外伤性角膜炎 (真菌性 )。采取抗菌、抗炎、对症治疗并散瞳。给予伊曲康唑 (商品名 :斯皮仁…     

伊曲康唑致严重不良反应1例

1 病例介绍患者,女,45岁,因左眼角膜穿通伤缝合术后,复发眼红、眼痛,使用地塞米松磷酸钠/新霉素(的确当)眼药水后无缓解来我院就诊.体检:视力Vd＝1.0,Vs＝FC/10cm,左眼混合性充血、角膜内上方见一已缝合斜形伤口,其周围角膜浅层溃疡,表面粗糙,其后近角膜缘处见一小块脓疡,前房水混浊,下方可见一积脓液面,高约0.5mm.瞳孔散大,直径6mm,晶体透明,眼底透照欠清,眼压Tn.临床诊断:左眼角膜穿通伤缝合术后,左眼外伤性角膜炎(真菌性).     

伊曲康唑的不良反应

伊曲康唑 (itraconazole ,斯皮仁诺 )是一种合成的广谱抗真菌药 ,临床上具有疗程短、疗效高、安全性大、依从性好的特点[1 ] 。随着伊曲康唑的广泛应用 ,有关其不良反应报道不断增多。1　水肿患者 ,男 ,因甲癣口服伊曲康唑 0 .2g ,每周 2次 ,服药 5d后出现双下肢水肿 ,水肿蔓延至全身及头面部 ,伴胸闷、气短、无发热 ,实验室检查均正常。立即停药 ,予利尿药及输液 1d后症状减轻 ,4d后症状消失[2 ] 。2　药疹患者 ,女 ,因指、趾甲癣予伊曲康唑间歇冲击疗法治疗。第1疗程服药 7d时 ,面部灼热肿胀瘙痒 ,经服马来那敏后痒止 ,服药 2疗程后面部红…     

伊曲康唑与氟康唑治疗甲真菌病的临床比较研究

目的分析研究伊曲康唑与氟康唑治疗甲真菌病的临床疗效及不良反应。方法将56例甲真菌病患者随机分为观察组和对照组各28例。观察组采用伊曲康唑治疗,对照组采用氟康唑治疗,分析两组的疗效。结果两组患者近期总有效率、近期治愈率、不良反应发生率比较,差异均无统计学意义（P〉0.05）。结论伊曲康唑治疗甲真菌病能获得与氟康唑相似的治疗效果,且不良反应轻微,临床上应选择两者中更为经济的药物推广使用。     

伊曲康唑致心力衰竭1例

1例65岁女性患者,因慢性支气管炎急性发作入院治疗,入院后考虑侵袭性曲霉菌感染,给予伊曲康唑片(0.2 g,qd)抗真菌治疗40 d后,患者出现双下肢水肿,喘憋等心衰症状,行血液检验B型钠尿肽前体(pro-BNP)升高至6817.0 pg·mL^-1。考虑为伊曲康唑引起的心力衰竭,停用伊曲康唑,给予螺内酯片、呋塞米片、氢氯噻嗪片改善心衰治疗17 d后,pro-BNP逐渐改善为1788.0 pg·mL^-1。因感染控制不佳再次使用伊曲康唑同时服用改善心衰的药物,用药6 d后,患者的pro-BNP再次升高为5172.0 pg·mL^-1,立即停用伊曲康唑。     

氟康唑与伊曲康唑治疗甲真菌病的疗效对比

目的：比较氟康唑与伊曲康唑治疗甲真菌病的疗效。方法选取2012年2月—2014年2月贺州市广济医院收治的甲真菌病患者60例,根据患者入院顺序将其随机分为治疗组与对照组,各30例。对照组患者予以伊曲康唑治疗,治疗组患者予以氟康唑治疗。观察两组患者近、远期临床疗效（停药3个月后观察两组近期疗效,停药6个月后观察两组远期疗效）、真菌学检查结果、住院费用及不良反应发生情况。结果停药3个月后两组患者总有效率比较,差异无统计学意义（P ﹥0.05）;停药6个月后两组患者总有效率比较,差异无统计学意义（ P ﹥0.05）;两组患者治疗后真菌转阴率比较,差异无统计学意义（ P ﹥0.05）;治疗组患者治疗费用低于对照组,差异有统计学意义（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）。结论伊曲康唑与氟康唑治疗甲真菌病的疗效相当,但氟康唑的不良反应少,价格低。     

氟康唑致麻疹样红斑1例

患者 ,女 ,32岁 ,因外阴、阴道念珠菌病 ,给予氟康唑片 (广东太阳神集团荔城制药厂生产 ,批号 0 10 70 91)单剂 0 15ｇ ,口服。次日 ,患者感觉浑身瘙痒 ,上肢内侧有少许小米粒状红斑出现。外用氟美松霜 ,症状减轻 ,未做其他处理。因治疗需要 ,第 4天又服氟康唑 0 15ｇ,第 5天早晨 ,患者出现皮疹 ,以颈部、躯干及四肢内侧为主 ,皮疹为弥漫性稍突出皮表 ,呈麻疹样。浑身瘙痒加重 ,抓痒后 ,皮下留有针尖样出血点。立即给予异丙嗪肌注及口服特非那丁 ,3天后皮疹消退。讨论 :氟康唑为新型三唑类抗真菌药 ,口服吸收良好 ,在体内分布广 ,对多种真…     

伊曲康唑致变态反应1例

1　病例介绍患者 ,男 ,3 6岁。因双足皮肤真菌感染口服伊曲康唑 (商品名 :斯皮仁诺 ,西安杨森制药有限公司生产 ,批号 :0 3 0 60 73 87)2 0 0mg ,1h后出现心悸、全身皮肤瘙痒等症状 ,继而面部、躯干、四肢出现皮疹 ,伴恶心、头晕。体检 :体温 3 6 7℃ ,心率 86次·min 1 ,呼吸     

伊曲康唑与氟氯唑对照治疗念珠菌肺炎患者的疗效及经济学分析

目的：比较伊曲康唑与氟康唑对念珠菌肺炎的疗效，并从药物经济学角度作比较。方法：念珠菌肺炎共52例，分为两组。治疗组30例，每天用 伊曲康唑片0．2－0．4g口服；对照组22例，每天用氟康唑0．2g静滴。两组疗程均为4周。结果：治疗组30例中有29例经治疗10天后症状均明显好转，有效率达96．67％，对照组22例中有18例经治疗10天后症状明显好转，有效率达81．82％，两组疗效无明显差异（P＞0．05）。结论：伊曲康唑对念珠菌肺炎的疗效与氯康唑相近，而费用仅为氯康唑的3％－4％。     

伊曲康唑与氟康唑治疗马拉色菌毛囊炎成本-效果分析

目的:评价口服伊曲康唑与氟康唑治疗马拉色菌毛囊炎的疗效及费用情况。方法:160例马拉色菌毛囊炎病人随机分为2组。伊曲康唑组85例,予伊曲康唑胶囊200 mg·d-1,口服,连续14 d;氟康唑组75例,予氟康唑胶囊150 mg·d-1,口服,连续14 d。治疗后进行成本-效果分析。结果:伊曲康唑组与氟康唑组治疗后的总有效率分别为87％(74／85)和83％(62／75)。成本-效果比(C／E)分别为3．87和4．24,增量成本-效果比(ΔC／ΔE)为-3．16。敏感度分析结果与参数改变前的结果基本一致。结论:伊曲康唑治疗马拉色菌毛囊炎有较佳的成本-效果比。     

Absence of clinically relevant drug interactions following simultaneous administration of didanosine-encapsulated, enteric-coated bead formulation with either itraconazole or fluconazole

This open-label, two-way crossover study was undertaken to determine whether the enteric formulation of didanosine influences the pharmacokinetics of itraconazole or fluconazole, two agents frequently used to treat fungal infections that occur with HIV infection, and whose bioavailability may be influenced by changes in gastric pH. Healthy subjects were randomized to Treatment A (200-mg itraconazole or 200-mg fluconazole) or Treatment B (same dose of itraconazole or fluconazole with 400 mg of didanosine as an encapsulated, enteric-coated bead formulation). In the itraconazole study, a lack of interaction was concluded if the 90% confidence interval (CI) of the ratio of the geometric means of log-transformed C(max) and AUC(0-T) values of itraconazole and hydroxyitraconazole, the active metabolite of itraconazole, were contained entirely between 0.75 and 1.33. In the fluconazole study, the equivalence interval for C(max) and AUC(0-T) was 0.80-1.25. The data showed that for itraconazole the point estimate and 90% CI of the ratios of C(max) and AUC(0-T) values were 0.98 (0.79, 1.20) and 0.88 (0.71, 1.09), respectively; for hydroxyitraconazole the respective values were 0.91 (0.76, 1.08) and 0.85 (0.68, 1.06). In the fluconazole study, the point estimate and 90% CI of the ratios of C(max) and AUC(0-T) values were 0.98 (0.93, 1.03) and 1.01 (0.99, 1.03), respectively. The T(max) for itraconazole, hydroxyitraconazole, and fluconazole were similar between treatments. Both studies indicated a lack of clinically significant interactions of the didanosine formulation with itraconazole or fluconazole. These results showed that the encapsulated, enteric-coated bead formulation of didanosine can be concomitantly administered with drugs, such as the azole antifungal agents, whose bioavailability may be influenced by interaction with antacids.     

Frequency of potential azole drug-drug interactions and consequences of potential fluconazole drug interactions

PURPOSE: To assess the frequency of potential azole-drug interactions and consequences of interactions between fluconazole and other drugs in routine inpatient care. METHODS: We performed a retrospective cohort study of hospitalized patients treated for systemic fungal infections with an oral or intravenous azole medication between July 1997 and June 2001 in a tertiary care hospital. We recorded the concomitant use of medications known to interact with azole antifungals and measured the frequency of potential azole drug interactions, which we considered to be present when both drugs were given together. We then performed a chart review on a random sample of admissions in which patients were exposed to a potential moderate or major drug interaction with fluconazole. The list of azole-interacting medications and the severity of interaction were derived from the DRUGDEX System and Drug Interaction Facts. RESULTS: Among the 4,185 admissions in which azole agents (fluconazole, itraconazole or ketoconazole) were given, 2,941 (70.3%) admissions experienced potential azole-drug interactions, which included 2,716 (92.3%) admissions experiencing potential fluconazole interactions. The most frequent interactions with potential moderate to major severity were co-administration of fluconazole with prednisone (25.3%), midazolam (17.5%), warfarin (14.7%), methylprednisolone (14.1%), cyclosporine (10.7%) and nifedipine (10.1%). Charts were reviewed for 199 admissions in which patients were exposed to potential fluconazole drug interactions. While four adverse drug events (ADEs) caused by fluconazole were found, none was felt to be caused by a drug-drug interaction (DDI), although in one instance fluconazole may have contributed. CONCLUSIONS: Potential fluconazole drug interactions were very frequent among hospitalized patients on systemic azole antifungal therapy, but they had few apparent clinical consequences.     

Dapsone-associated fixed drug eruption

Introduction: Dapsone is a sulfone drug used to treat infectious conditions and also numerous dermatologic diseases. Fixed drug eruption is a distinctive adverse cutaneous reaction associated with the initial administration and subsequent delivery of a specific agent.

Areas covered: The authors preformed a literature search using the following keywords: dapsone, fixed drug eruption, and adverse cutaneous drug reaction. Bibliographies were also reviewed for pertinent articles. The results were combed for relevant papers and reviewed. Articles pertaining to dapsone-associated fixed drug eruption were included.

Expert commentary: The majority of cases of dapsone-associated fixed drug eruption in the literature come from Africa or India where there is a high prevalence of patients treated for leprosy. Characteristics of these cases are similar to fixed drug eruption described in the western literature, with differences in frequency of multiple versus solitary lesions. Dapsone-associated fixed drug eruption should be considered when reviewing the drug history of a patient with fixed drug eruption. In the case of darker pigmented individuals, multiple fixed drug eruption lesions may be more common. Multiple lesions may mimic Kaposi’s sarcoma in human immunodeficiency virus positive patients. Dapsone-associated fixed drug eruption should be considered in the differential diagnosis of multiple hyperpigmented lesions.     

Terbinafine-induced lichenoid drug eruption

Drug-induced lichen planus has been induced by antibiotics, anticonvulsants, antidiabetics, antimalarials, antitubercular drugs, antihypertensives, psychiatric drugs, chemotherapeutic agents, diuretic, heavy metals, NSAIDs, etc. Terbinafine, an antifungal agent, is widely used for dermatophyte infections and onychomycosis. Cutaneous adverse effects of terbinafine are rarely reported. Here, we report a case of terbinafine-induced lichenoid drug eruption in a 22-year-old who presented with generalized lichenoid eruption 2 weeks after terbinafine initiation of. The body and lip cleared completely after 8 weeks of drug withdrawal; nail change cleared after 12 weeks.     

别嘌醇所致药疹的临床特征及其肾功能与预后的关系简

目的：探讨别嘌醇引起药疹的临床特征以及病情轻重、预后与肾功能的关系.方法：对1995-2010年复旦大学附属华山医院病房收治的156例别嘌醇药疹进行回顾性分析.结果：别嘌醇引起药疹的潜伏期为（41.8＆±14.3）d,病人住院时间为（36.8±11.2）d,重症多形红斑型、剥脱性皮炎型及大疱性表皮坏死松解型药疹占42.3％,全身症状重,死亡12例.病情轻重与肾功能损害的程度密切相关（P＜0.05）,疾病的预后也与肾功能损害的程度密切相关（P＜0.01）.结论：别嘌醇所致的药疹具有潜伏期长、病程长、皮疹重、全身症状重等特点,其肾功能损害的程度可影响病情的轻重和疾病的预后.     

五年住院药疹病例回顾性分析

目的探讨药疹的临床特点、诊断治疗方法及药物种类与药疹类型的关系。方法对我院2009年1月至2014年2月收治的住院药疹患者的临床资料进行回顾性分析。结果 510例药疹中Naranjo评分≥5分者共461例,其中男133例,女328例。244例(52.93%)为单一致敏药物,以抗菌药物、中成药、非甾体抗炎药为主;重症药疹61例(13.23%),非重症药疹400例(86.77%),两组在年龄、潜伏期、临床特征及实验室检查方面差异有统计学意义(P<0.05)。结论发疹型及荨麻疹型最为常见,抗菌药物较易导致发疹型药疹,而生物制剂较易引发荨麻疹型药疹,抗痛风药及抗癫疒间药较易引起重症药疹。对药疹的病因学诊断及预防应提出更高要求。     

35株念珠菌对氟康唑的敏感性及与环孢素联合的体外协同作用

目的研究肺部感染患者痰中念珠菌对氟康唑（抗真菌药）的敏感性及与环孢素（免疫抑制剂）联合的体外协同作用.方法按M-27A药敏试验,绘制氟康唑对念珠菌的杀菌曲线,分析氟康唑与环胞素联合对念珠菌的体外协调作用.结果大部分念珠菌对环孢素和氟康唑敏感;联合试验中,氟康唑对念珠菌的最小抑菌浓度未改变;当氟康唑浓度＞MIC时,与环孢素呈协同作用,杀菌作用增强;增加念珠菌接触浓度后,真菌生长计数减少.结论绝大多数念珠菌对氟康唑敏感;与环孢素合用后,杀菌作用增强.