Study of oral itraconazole and terbinafine pulse therapy in onychomycosis

In this open, randomized and comparative study, the safety and efficacy of systemic intermittent itraconazole and terbinafine was examined in 30 patients with onychomycosis. The patient with positive mycological culture and also the patients with positive microscopy and negative culture were investigated. Patients were randomly assigned: 15 patients in each group received either 200mg itraconazole or 250 mg terbinafine twice daily during the first week of a 4 weeks cycle. The treatment duration was 16 weeks and was followed-up for 36 weeks. Both the treatment regimen showed significant reduction in onychomycosis affected areas after 8 weeks and maximum reduction was observed at the end of 36 weeks. At the end point of the follow-up period, the clinical cure rates (no residual deformity or with some deformity) were 86.7% in the itraconazole group and 100% in the terbinafine group. The mycological cure rates were 86.7% and 100% respectively. However, no statistically significant differences between the treatment groups were seen in clinical, mycological (P= 0.864) and severity assessment (P= 0.220). Nausea, abdominal cramp, headache, back pain and flu like syndrome are the adverse effects more frequently reported. At least one adverse effect was reported by 17 patients, of them 12 belonged to itraconazole group and 5 to terbinafine group and the difference was statistically significant (P= 0.027). The overall therapeutic effectiveness, safety and cost affectivity were in favor of Terbinafine pulse therapy.     

应用人表皮角质层体外真菌培养法评价伊曲康唑的抗菌活性

目的　建立一种与体内环境相似的新模型,用以更好地评价和比较抗真菌药物的抗真菌活性。方法　将21名健康志愿者随机分为两组,第1组11例,口服伊曲康唑200mg,每日2次,用药1周;第2组10例,口服伊曲康唑200mg,每日1次,用药1周。两组对象于服药前、后1、4、7、10、14、21、28、35d分别制备皮肤角质层剥离条作为培养基,将红色毛癣菌、须癣毛癣菌和犬小孢子菌孢子的菌悬液接种于皮肤角质层剥离条的中央,培养1周,常规行PAS染色,采用角质层真菌定量生物分析法,并用计算机辅助图像分析测定被皮肤癣菌的菌丝所覆盖的面积。结果　3种皮肤癣菌在人体皮肤角质层剥离条上均可生长,服药前被菌丝覆盖的面积稠密,随着服药时间的延长,菌丝面积逐渐减少,即服用伊曲康唑后真菌的生长受到抑制,至服药第7天降至最低;服药第10天菌丝面积开始随时间的延长而增多,至第35天增至最多。两种剂量的伊曲康唑对3种皮肤癣菌均显示了明显的抗真菌活性,但两组间差异无统计学意义(P>0. 05)。结论　真菌在人体角质层剥离条上的生长环境与人体内环境相似,伊曲康唑在人体角质层显示了很高的抗皮肤癣菌的活性。角质层真菌定量生物学分析法是介于体外试验与体内疗效之间的一种新方法的有效尝试。     

特比萘芬加联苯苄唑乳膏治疗足癣疗效观察

目的 探讨特比萘芬加联苯苄唑乳膏即"1+1"疗法联合治疗足癣的疗效.方法 采用特比萘芬加联苯苄唑乳膏联合治疗足癣78例,并与单一口服特比萘芬治疗足癣(76例)和单一外用联苯苄唑乳膏治疗足癣(60例)进行疗效对比.结果 "1+1"疗法组治愈率和有效率分别为84.62%和97.44%,而单一口服特比萘芬和单一外用联苯苄唑乳膏组治愈率和有效率分别为63.16%、63.33%和76.32%、76.66%."1+1"疗法组与单一给药两组治愈率比较均有显著性差异(x2=9.218,P=0.002;x2=8.273,P=0.004),而单一给药两组间治愈率比较无显著性差异(x2=0.000<0.01,P=0.983>0.05).结论 "1+1"疗法和单一口服药物疗法、单一外用药物疗法治疗足癣均有效,但以"1+1"疗法最佳.     

特比萘芬联合派瑞松霜治疗念珠菌性包皮龟头炎的临床疗效观察

目的观察特比萘芬联合派瑞松霜治疗念珠菌性包皮龟头炎的临床疗效。方法92例随机分为对照组(派瑞松霜)和治疗组(派瑞松霜 特比萘芬),派瑞松霜外涂,特比萘芬片口服,连用14d。所有患者分别于治疗当日及用药后第7d、第14d记录临床症状及体征,并行真菌镜检,判断疗效。结果用药7d时,对照组的显效率为67.4%,而治疗组为84.8%,两组间有显著的统计学差异(P<0.05);真菌学检查发现,对照组和治疗组的真菌清除率有显著的统计学差异(P<0.05)。在用药14d时,对照组和治疗组的显效率分别为80.4%和93.5%,在统计学上有显著性差异(P<0.05);但两组的真菌学疗效间无显著性差异(p>0.05)。两组均未见红肿、瘙痒、刺痛等不良反应,患者耐受性好。结论特比萘芬联用派瑞松霜治疗复发性念珠菌性包皮龟头炎是值得临床推荐的治疗方法。     

特比萘芬软膏与复方酮康唑乳膏治疗浅部真菌病疗效比较

目的特比萘芬与复方酮康唑外用治疗皮肤浅部真菌病的疗效比较。方法浅部真菌病患者60例,随机分为特比萘芬组30例(应用特比萘芬软膏外涂患处,Bid×2周)和复方酮康唑组30例(外用复方酮康唑乳膏,Bid×2周);在停药时及停药2周后观察疗效。结果治疗结束时,特比萘芬组总有效率为73%(22/30),明显高于复方酮康唑组为57%(17/30)(P<0.05);停药2周后,特比萘芬组总有效率为97%(29/30),明显高于复方酮康唑组为47%(14/30)(P<0.05)。治疗结束时,特比萘芬组真菌清除率为83%,明显高于复方酮康唑组为53%(P<0.05),停药2周后,特比萘芬组真菌清除率为97%,明显高于复方酮康唑组为37%(P<0.01)。2组均未见明显不良反应。结论特比萘芬治疗浅部真菌病疗效优于复方酮康唑。     

地奈德乳膏联合透明质酸修护生物膜对女性面部皮炎的治疗效果

目的分析地奈德乳膏联合透明质酸修护生物膜对女性面部皮炎的治疗效果。方法收集2017年1～12月海军军医大学第一附属医院皮肤科门诊就诊的面部皮炎女性患者80例,并将患者按照随机数字表法分成试验组(n=42)及对照组(n=38),试验组给予地奈德乳膏外用,仅限于面部皮损处,同时予透明质酸修护生物膜外涂于皮损及正常皮肤;对照组仅给予地奈德乳膏外用。两组患者同时给予抗组胺药物左西替利嗪口服。治疗16 d后对两组患者的皮损情况、治疗效果及治疗后4周的皮损复发率进行比较。结果治疗前,两组患者的特应性皮炎评分(SCORAD)差异无统计学意义(P>0.05);治疗后,两组患者的SCORAD评分均有改善,且试验组SCORAD评分改善情况优于对照组(P<0.05);试验组治疗有效率为88.10%,高于对照组的65.79%(P<0.05);停止治疗2周后,试验组复发率为24.14%(7/29),低于对照组的58.82%(10/17),差异均有统计学意义(P<0.05)。结论透明质酸修护生物膜联合地奈德乳膏可提高女性面部皮炎的临床疗效,且复发率低。     

特比萘芬与萘替芬酮康唑联合治疗外耳道真菌病的疗效分析

目的观察口服特比萘芬联合外用萘替芬酮康唑治疗外耳道真菌病的疗效、安全性。方法将66例外耳道真菌病患者随机分为两组：治疗组34例,口服特比萘芬联合外用萘替芬酮康唑,疗程1月;对照组32例,局部外用萘替芬酮康唑,疗程1月。结果治疗组1月后有效率为94.1%,高于对照组的53.1%,有显著性差异。结论联合疗法和单一外用药物治疗外耳道真菌病均有效,但联合疗法起效快、疗程短、效果好。     

伊曲康唑短期疗法治疗男性念珠菌性尿道炎34例临床分析

目的:探讨伊曲康唑口服短期疗法治疗男性念珠菌性尿道炎的疗效。方法:34例男性念珠菌性尿道炎患者给予伊曲康唑200 mg,2次/d,连服3d,停药2周后观察疗效。结果:临床疗效:治愈率85.3%,有效率97.0%;真菌学疗效:治愈率94.1%。结论:伊曲康唑3日疗法治疗男性念珠菌性尿道炎疗效高,疗程短,不良反应小,值得推广应用。     

Efficacy and safety of intravenous itraconazole followed by oral itraconazole solution in the treatment of invasive pulmonary mycosis

Background  Invasive pulmonary mycosis is the most common type of invasive fungal infection. It is often severe and difficult to treat, and is accompanied by high mortality. In this study, we aimed to evaluate the efficacy and safety of intravenous itraconazole followed by oral itraconazole solution in the treatment of invasive pulmonary mycosis and to determine the distribution of different fungi species.

Methods  This was a multi-center, open-label study which enrolled 71 patients who were diagnosed as invasive pulmonary mycosis between July 2007 and January 2009. All patients received intravenous itraconazole therapy followed by oral itraconazole solution with a total treatment duration of 6 weeks. Intravenous itraconazole was given at a dose of 200 mg bid (intravenous infusion every 12 hours) for the first two days, 200 mg qd for the subsequent 12 days. Sequential oral itraconazole solution was given at a dose of 200 mg bid for 4 weeks. Efficacy and safety were assessed according to clinical as well as microbiological criteria.

Results  Seventy one patients participated in this study. Of the 60 patients in the full analysis dataset, the clinical response rate was 61.7% and the mycological eradication rate was 66.7%. The overall response rate was 66.7%. Drug-related adverse events occurred in 18.0% of patients: hypokalemia, liver function impairment and mild gastrointestinal side effects were the most common. One patient suffered from severe adverse event, with limb and facial swelling.

Conclusion This study showed that in patients with invasive pulmonary mycosis, intravenous itraconazole followed by oral itraconazole solution therapy was safe and effective.

     

派瑞松霜治疗阴囊湿疹的临床研究

目的 观察派瑞松霜对阴囊湿疹的疗效及安全性。方法 64例患者随机分为治疗组及对照组，分别应用派瑞松霜和地基米松软膏治疗。结果 治疗第1周治疗组及对照组总有效率分别为53．1％和28．1％，第2周分别为84．4％和50．0％，第3周分别为93．8％和71．9％，两组间比较差异均有显著性（P〈0．05）。结论 派瑞松霜外用治疗阴囊湿疹安全有效。值得临床选用。     

硫软膏联合尤卓尔乳膏治疗小儿丘疹性荨麻疹50例的疗效观察

目的 观察硫软膏联合尤卓尔乳膏治疗小儿丘疹性荨麻疹的临床疗效.方法 将104例患者随机分为治疗组和对照组.治疗组50例用硫软膏联合尤卓尔乳膏混合后外涂患处,3次/d,连用6 d.对照组54例予恩肤霜外用患处,3次/d,连用6 d.结果 治疗组用药后第2天的痊显率为74.0%,高于对照组的40.7%（χ2=11.70,P〈0.005）,治疗组治愈率为48.0%,高于对照组的25.9%（χ2=5.46,P〈0.05）,平均治愈时间治疗组为（3.08±1.09）d,短于对照组的（3.78±1.09）d（t=3.66,P〈0.001）.结论 硫软膏联合尤卓尔乳膏治疗小儿丘疹性荨麻疹较单纯使用皮质类固醇激素的思肤霜治疗起效快、疗程短、疗效显著.     

地奈德乳膏联合丝塔芙润肤露治疗婴幼儿湿疹疗效观察

目的观察地奈德乳膏联合丝塔芙润肤露治疗婴幼儿湿疹的疗效及安全性。方法 183例婴幼儿湿疹患者随机分成联合治疗组、地奈德乳膏治疗组及丝塔芙治疗组,联合治疗组初诊时外用地奈德乳膏和丝塔芙润肤露,分别涂于患处,2次/d,待皮疹消退后改单用丝塔芙润肤露继续保湿治疗,地奈德乳膏组单独外用地奈德乳膏,2次/d,待皮疹消退后改为1次/d,丝塔芙组单独外用丝塔芙润肤露,2次/d。均连用14天。在第7天、14天及痊愈后7天记录皮疹情况。观察皮疹变化,对红斑、丘疹、鳞屑,瘙痒及面积的总积分进行评价。结果 7天后联合治疗组有效率和痊愈率分别为63.93%和47.54%,均高于单独使用丝塔芙组。在治疗14天后联合治疗组有效率和痊愈率分别为91.80%和68.85%,均高于单独应用地奈德乳膏组与丝塔芙组,而单独使用地奈德乳膏组与丝塔芙组有效率和痊愈率基本相当。结论地奈德乳膏联合丝塔芙润肤露在婴幼儿湿疹治疗中疗效明显,安全。     

地奈德乳膏联合尿素乳膏治疗手部湿疹疗效及生活质量分析

目的研究分析地奈德乳膏联合尿素乳膏对于患者手部湿疹的治疗效果,并探讨患者生活质量。方法选择我院在2010年10月～2011年10月收治的手部湿疹患者100例。将所有患者随机分为两组．观察组和对照组各50例。对照组采用丁酸氢化可的松乳膏联合10％尿素乳膏治疗,观察组采用地奈德乳膏联合10％尿素乳膏治疗。两组患者用药均为2次/d,并且连续用药2周。对两组治疗2周后的临床效果做比较。并对两组患者的生活质量做相应的问卷调查。结果观察组治疗有效率为92％,明显高于对照组64％的治疗有效率,差异具有统计学意义,P〈0．05。观察组患者在生活质量改善程度上也明显优于对照组,差异具有统计学意义,P〈0．05。结论采用地奈德乳膏联合尿素乳膏治疗手部湿疹的治疗效果比较好,并且能够有效改善患者的生活质量,值得在临床上广泛运用。     

Treatment of dermatophyte toenail onychomycosis in the United States. A pharmacoeconomic analysis

This study attempted to determine the cost-effectiveness of therapies for dermatophyte toenail onychomycosis in the United States in 2001. The antimycotic agents evaluated were ciclopirox 8% nail lacquer and the oral agents terbinafine, itraconazole (pulse), itraconazole (continuous), fluconazole, and griseofulvin. A treatment algorithm for the management of onychomycosis was developed, and a meta-analysis was carried out to determine the average mycologic and clinical response rates for the various agents. The cost of the regimen was figured as the sum of the costs of drug acquisition, medical management, and management of adverse effects. The expected cost of management and disease-free days were determined, and a sensitivity analysis was conducted. It was concluded that ciclopirox 8% nail lacquer, which has recently become available in the larger size of 6.6 mL, is a cost-effective agent for the management of toenail onychomycosis.     

三种常见抗真菌药口服治疗甲真菌病疗效观察

目的了解伊曲康唑、特比萘芬和氟康唑口服治疗甲真菌病的疗效。方法63例患者根据治疗药物的不同分为三组,伊曲康唑组41例,特比萘芬组13例,氟康唑组9例。分别在疗程结束后3个月和6个月时,进行真菌学检查和临床症状观察。结果伊曲康唑、特比萘芬和氟康唑治疗结束3个月和6个月的临床有效率分别为87．80％和92．68％、84．62％和92．31％、88．89％和88．89％;治疗结束3个月和6个月真菌学治愈率一致,分别为100％、92．31％和100％％。结论伊曲康唑与特比萘芬和氟康唑治疗甲真菌病均能取得较好的疗效。美扶因价格相对便宜,抗菌谱更广,具有更高的效价比。     

Fonsecaea monophora致着色芽生菌病一例报道并文献复习

目的　利用分子生物学方法鉴定1例Fonsecaea monophora致着色芽生菌病（CBM）,观察伊曲康唑联合特比萘芬治疗的效果。方法　回顾性分析2015-03-22广东省人民医院皮肤科收治的1例Fonsecaea monophora致CBM患者的临床资料。观察真菌培养、镜检、病理检查、DNA测序、体外药敏试验情况以及口服伊曲康唑联合特比萘芬治疗情况。复习相关文献并进行讨论。结果　患者左手虎口部位创伤后引发疣状增生斑块长达11年。沙氏葡萄糖琼脂培养基（SDA）上可见暗棕色、橄榄色至黑色菌落,镜下可见枝孢型和喙枝孢型分生孢子,病理结果显示可见棕色厚壁孢子。ITS区序列分析鉴定为Fonsecaea monophora,结合临床特征及实验室检查确诊为Fonsecaea monophora致CBM,体外抗真菌药敏结果提示该Fonsecaea monophora菌株对伊曲康唑和特比萘芬敏感。口服伊曲康唑（200 mg/d）联合特比萘芬（250 mg/d）,共治疗9个月,病情痊愈,随访6个月未见复发。治疗过程中全程检测肝、肾功能,未发生异常。结论　伊曲康唑联合特比萘芬成功治愈1例Fonsecaea monophora致CBM,并取得满意的治疗效果。     

地奈德乳膏联合薇诺娜宝贝舒润滋养霜治疗婴幼儿湿疹疗效观察

目的 探讨婴幼儿湿疹薇诺娜宝贝舒润滋养霜联合地奈德乳膏治疗的疗效。方法 回顾性选取2019 年6 月至2020 年6 月本院婴幼儿湿疹患儿100 例,依据治疗方法分为单独地奈德乳膏治疗组（单独治疗组,n=50）与薇诺娜宝贝舒润滋养霜联合地奈德乳膏治疗组（联合治疗组,n=50）两组,对两组患者的症状体征评分、临床疗效、不良反应发生情况、复发情况进行统计分析。结果 联合治疗组患儿治疗后较治疗前的瘙痒程度、皮损情况、皮损范围评分及总分降低幅度均显著高于单独治疗组,差异有统计学意义（P<0.05）。联合治疗组患者治疗的总有效率为92.0%（46/50）,显著高于单独治疗组的64.0%（32/50）,差异有统计学意义（P<0.05）。联合治疗组不良反应发生率为8.0%（4/50）,单独治疗组为6.0%（3/50）,两组比较,差异无统计学意义（P>0.05）;联合治疗组患者的复发率为6.0%（3/50）,显著低于单独治疗组的38.0%（19/50）（P<0.05）。结论 婴幼儿湿疹采用薇诺娜宝贝舒润滋养霜联合地奈德乳膏治疗的疗效较单独地奈德乳膏治疗显著。     

维阿露联合丙酸氟替卡松软膏治疗白癜风疗效观察

目的观察维阿露联合丙酸氟替卡松软膏治疗白癜风的临床疗效和安全性。方法将62例稳定期白癜风患者随机分为3组，试验组外用维阿露联合丙酸氟替卡松软膏，对照1组外用维阿露，对照2组单用丙酸氟替卡松软膏。结果试验组、对照1组、对照2组的有效率分别为81．9％、45．0％、40．0％。试验组与对照1组、对照2组差异均有统计学意5C（P〈0．05）；各组间痊愈率比较，差异均无统计学意义（P〉0．05）。就部位而言，试验组头面部有效率优于躯干部（P〈0．05），头面部有效率显著优于四肢（P〈0．01）。试验组与对照组药物相关不良反应发生率无差异（P〉0．05）。结论维阿露联合丙酸氟替卡松照射治疗白癜风有效。     

鸦胆子乳膏治疗外阴菜花型尖锐湿疣临床观察

目的:观察鸦胆子乳膏治疗外阴尖锐湿疣的疗效,探讨治疗尖锐湿疣的最佳药物.方法:对确诊尖锐湿疣在阴道镜下分型为菜花型的患者,选用鸦胆子乳膏药物治疗(为观察组)及激光治疗(为对照组)各100例.结果:鸦胆子乳膏治愈率100%,平均治愈时间14 d,对周围皮肤粘膜无损伤,患者无痛苦及不适;激光治愈率100%,平均治愈时间39 d.患者有烧灼感,疼痛及溃疡形成.结论:鸦胆子乳膏治疗菜花型尖锐湿疣治愈率高,且患者无痛苦及不适,可作为首选药物,有研究及开发价值.     

口服特比萘芬加外用益康唑短程联合疗法治疗足癣的临床对照研究

目的评价口服特比萘芬片加外用益康唑乳膏短程联合疗法治疗足癣的疗效和安全性。方法采用随机数字表法将124名患者分为两组：试验组予特比萘芬片250mg口服,1次／d,联合盎康唑乳膏外用,2次／d,共7d;对照组予益康唑乳膏外用,2次／d,同时口服维生索C片0．1g,1次／d,共28d。于停药时和停药后4周时观察临床疗效和真蔺学疗效,停药后4同时观察复发情况。结果共有113例患者完成临床观察．脱落7例（试验组1例,对照组6例）,剔除4例（对照组4例）。停药时两组相比试验组治愈率明显低于对照组（χ^2=23．03,P〈0．01）,有效率及真菌清除率差异无统计学意义（χ^2=0．33,P〉0．05;χ^2=0．03,P〉0．05）;停药后4周时两组相比试验组治愈率、有效率及真菌清除率均显著高于对照组（χ^2=17．21,P〈0．01;χ^2=14．56,P〈0．01;）（χ^2=23．03,P〈0．01）;停药后4周时两组相比试验组复发率明显低于对照组（χ^2=14．04,P〈0．01）;两组不良反应发生率相比差异无统计学意义（χ^2=3．27,P〉0．05）。结论口服特比萘芬片加外用益康唑乳膏短程联合疗法治疗足癣依从性和安全性高、疗效好。