3种方案治疗念珠菌性阴道炎的费用-效果分析

目的探讨3种方案治疗念珠菌性阴道炎的经济效果.方法选择98例念珠菌性阴道炎患者,随机分为3组分别给予硝酸咪唑栓阴道塞药+口服伊曲康唑胶囊、特比萘芬片阴道塞药、口服氟康唑胶囊进行治疗,应用药物经济学的费用-效果分析方法进行评价.结果 3种方案的治疗效果均好,而硝酸咪唑栓阴道塞药+口服伊曲康唑胶囊的价格最低.结论通过药物经济学的分析,硝酸咪唑栓+伊曲康唑为治疗念珠菌性阴道炎的理想方案.     

3种抗真菌药治疗甲真菌病药物经济学分析

目的对伊曲康唑、特比萘芬、氟康唑3种不同抗真菌药物治疗120例甲真菌病患者的成本效果分析。方法选择120例病例,随机分为3组,分别给予伊曲康唑、特比萘芬、氟康唑治疗,观察各组疗效并运用药物经济学方法进行分析。结果3种药物均有较好的抗真菌疗效,特比萘芬疗效优于伊曲康唑及氟康唑,伊曲康唑疗效优于氟康唑。平均成本-效果比分别为8.9,8.0,11.7。结论药物经济学分析结果为特比萘芬治疗甲真菌病最优。     

特比萘芬与氟康唑或伊曲康唑体外联合抗白念珠菌的作用

目的探讨特比萘芬与氟康唑或伊曲康唑体外联合抗白念珠菌的作用。方法采用微量液体稀释法测定特比萘芬、氟康唑、伊曲康唑对生殖器部位分离的36株白念珠菌药敏试验，应用棋盘微量稀释法测定特比萘芬与氟康唑或伊曲康唑对36株白念珠菌的联合药敏试验。结果白念珠菌菌株对氟康唑、伊曲康唑、特比萘芬耐药株分别为3株（8．33％）、4株（11．11％）、6株（16．67％）。特比萘芬和氟康唑联用MIC几何平均数较其单独应用均显著降低（t=3．590，P〈0．05；t=3．252，P〈0．05），15株有协同作用（42％），18株有相加作用（50％），3株无关作用（8％）；特比萘芬和伊曲康唑联用后的MIC几何平均数较其单独应用均显著降低（t=3．849，P〈0．001；t=2．409，P〈0．05），表现为协同作用有14株（39％），相加作用的有17株（47％），无关作用的有5株（14％）；均未发现拮抗作用。结论特比萘芬与氟康唑或伊曲康唑联合应用对大部分白念珠菌能产生协同作用和相加作用，提示特比萘芬与氟康唑或伊曲康唑联合应用能增强抗白念珠菌的作用。     

伊曲康唑与氟康唑口服治疗念珠菌性阴道炎成本－效果分析

目的探讨伊曲康唑与氟康唑口服治疗念珠菌性阴道炎的成本－效果分析。方法收集2013年9月～2014年12月我院诊断为念珠菌性阴道炎的患者作为本次研究对象，按随机号码表法分为两组，100例伊曲康唑组（0．2g，1日2次，总疗程为7d）和100例氟康唑组（150mg 1日1次，总疗程为3d）。对比①两组治疗疗效、治疗后6个月念珠菌性阴道炎复发率。②两组治疗念珠菌性阴道炎的成本－效果比。③两组治疗念珠菌性阴道炎的敏感度。结果①伊曲康唑组与氟康唑组治疗念珠菌性阴道炎的有效率分别为98％、96％，差异无统计学意义（ P＞0．05）。②伊曲康唑与氟康唑治疗念珠菌性阴道炎的成本－效果比分别为0．91、0．20，可以看出氟康唑治疗念珠菌性阴道炎具有明显的成本－效果比优势，而且氟康唑每加一个效果单位（△C／△E）所花费的成本也较伊曲康唑组低。③伊曲康唑组与氟康唑组治疗念珠菌性阴道炎的敏感度分别为88％、80％，基本无差异（ P＞0．05）。结论本次研究认为念珠菌性阴道炎的治疗方案中可以选择成本－效果具有优势的氟康唑口服。     

特比萘芬、伊曲康唑和氟康唑治疗甲真菌病疗效和安全性观察

目的研究特比萘芬、伊曲康唑和氟康唑治疗甲真菌病疗效和安全性。方法将2007年3月至2009年5月,就诊的150例甲真菌病随机分为三组,特比萘芬组50例,口服特比萘芬250mg,1次／d,指甲真菌病患者连用12周,趾甲真菌病患者连用16周;伊曲康唑组50例,口服伊曲康唑200mg,2次／d,冲击治疗,连用1周,停药3周为1个疗程,连续3～4个疗程;氟康唑组50例,口服氟康唑300mg,1次／周,顿服,共3～4个月疗程。结果服药后3M、6M各组的有效率分别为78％、78％和76％,86％、88％和84％,试验中没有发生严重不良反应。结论特比萘芬、伊曲康唑和氟康唑治疗甲真菌病疗效显著,差异无显著性,安全性高。     

特比萘芬与氟康唑联合治疗复发性念珠菌性阴道炎的疗效观察

目的：观察特比萘芬与氟康唑联合疗法治疗复发性念珠菌性阴道炎的疗效和安全性。方法：随机选择复发性念珠菌性阴道炎患，口服特比萘芬250mg，每天2次。连用3天；紧接着口服氟康唑1天300mg，分2次服。停药后7-10天和28-32天，58-60天分别判断近期疗效和远期疗效及真菌复发。结果：治疗后近期及远期临床有效率分别为89.7%(78/87)和97.7%(85/87)，近期及远期真菌学治愈率为90.8%(79/87),97.7%(85/87)；真菌复发率为3.5%(3/85)。其中耐药性念珠菌阴道炎的近期及远期真菌学治疗率分别为74.2%(23/31),93.5%(29/31)/真菌复发率为6.9%(2/29)；副作用发生率为5.7%(5/87)。结论：特比萘芬与氟康唑联合疗法是治疗复发性念珠菌性阴道炎的有效方法。     

3种方案治疗念珠菌性阴道炎的费用-效果分析

目的探讨3种方案治疗念珠菌性阴道炎的经济效果。方法选择98例念珠菌性阴道炎患者，随机分为3组分别给予硝酸咪唑栓阴道塞药 口服伊曲康唑胶囊、特比萘芬片阴道塞药、口服氟康唑胶囊进行治疗，应用药物经济学的费用-效果分析方法进行评价。结果3种方案的治疗效果均好，而硝酸咪唑栓阴道塞药 口服伊曲康唑胶囊的价格最低。结论通过药物经济学的分析，硝酸咪唑栓 伊曲康唑为治疗念珠菌性阴道炎的理想方案。     

两种国产抗真菌药治疗念珠菌性包皮龟头炎疗效观察

目的评价两种国产抗真菌药治疗包皮龟头炎的临床疗效及安全性。方法156例念珠菌性包皮龟头炎患者采用信封方法随机分为两组,特比奈芬组给予特比萘芬0．25g,每天1次口服;伊曲康唑组给予伊曲康唑0．2g,每天1次于餐时服用。两组疗程均为7d。结果特比奈芬组有效率为93．4％,高于伊曲康唑组的78．8％（P〈0．01）;患者各项症状、体征体征消退时间,特比奈芬组明显较伊曲康唑组缩短（P〈0．01）。结论国产特比奈芬治疗念珠菌性包皮龟头炎较国产伊曲康唑疗效好,不良反应少。     

三种给药方案治疗念珠菌性阴道炎的成本-效果分析

目的：评价三种给药方案治疗念珠菌性阴道炎的疗效与经济成本。方法：480例念珠菌性阴道炎患者随机分为盐酸特比萘酚片（A组）、氟康唑胶囊（B组）和伊曲康唑胶囊（C组）三组,分别给予口服盐酸特比萘酚片、氟康唑胶囊和伊曲康唑胶囊,三组均联合达克宁栓剂外用治疗,同时采用成本-效果分析法对三组进行评价。结果：A组、B组和C组三组的有效率分别为86.25%、88.75%和91.875%,成本分别为97.07、57.21和82.44元。结论：氟康唑胶囊组方案较经济。     

3种方案治疗念珠菌性阴道炎的费用-效果分析

目的探讨3种方案治疗念珠菌性阴道炎的经济效果。方法选择98例念珠菌性阴道炎患者,随机分为3组分别给予硝酸咪唑栓阴道塞药 口服伊曲康唑胶囊、特比萘芬片阴道塞药、口服氟康唑胶囊进行治疗,应用药物经济学的费用效果分析方法进行评价。结果3种方案的治疗效果均好,而硝酸咪唑栓阴道塞药 口服伊曲康唑胶囊的价格最低。结论通过药物经济学的分析,硝酸咪唑栓 伊曲康唑为治疗念珠菌性阴道炎的理想方案。     

不同区域女性阴道念珠菌感染分析284例

目的了解阴道念珠菌病患者不同区域女性阴道念珠菌感染及耐药现状。方法通过广汉市第二人民医院妇产科对阴道念珠菌患者采取阴道分泌物余片,经革兰染色镜检菌株,然后进行鉴定及药敏试验。结果本文共鉴定284株念珠菌,其中白色念珠菌检出率占首位87.1%,其次光滑念珠菌检出率11.4%。药敏结果显示,白色念珠菌对5-氟胞嘧啶、衣曲康唑、氟利康唑、制霉素耐药率均<30.5%,较敏感,氟康唑率均>51.3%以上,总耐药率>56.8%以上,敏感性较差。而光滑念珠菌对5-氟胞嘧啶、氟康唑、氟利康唑、衣曲康唑、制霉菌素耐药率均<23.1%,敏感性较好,光滑念珠菌对氟康唑耐药率100%,不敏感。结论白色念珠菌和光滑念珠菌是主要的阴道致病菌,不同种类耐药性有所差异,城市与农村女性的感染率,复发率有差异,应加强病原菌的耐药性检测。     

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.     

A risk-benefit assessment of the newer oral antifungal agents used to treat onychomycosis.

The newer antifungal agents itraconazole, terbinafine and fluconazole have become available to treat onychomycosis over the last 10 years. During this time period these agents have superseded griseofulvin as the agent of choice for onychomycosis. Unlike griseofulvin, the new agents have a broad spectrum of action that includes dermatophytes, Candida species and nondermatophyte moulds. Each of the 3 oral antifungal agents, terbinafine, itraconazole and fluconazole, is effective against dermatophytes with relatively fewer data being available for the treatment of Candida species and nondermatophyte moulds. Itraconazole is effective against Candida onychomycosis. Terbinafine may be more effective against C. parapsilosis compared with C. albicans; furthermore with Candida species a higher dose of terbinafine or a longer duration of therapy may be required compared with the regimen for dermatophytes. The least amount of experience in treating onychomycosis is with fluconazole. Griseofulvin is not effective against Candida species or the nondermatophyte moulds. The main use of griseo-fulvin currently is to treat tinea capitis. Ketoconazole may be used by some to treat tinea versicolor with the dosage regimens being short and requiring the use of only a few doses. The preferred regimens for the 3 oral antimycotic agents are as follows: itraconazole - pulse therapy with the drug being administered for 1 week with 3 weeks off treatment between successive pulses; terbinafine - continuous once daily therapy; and fluconazole - once weekly treatment. The regimen for the treatment of dermatophyte onychomycosis is: itraconazole - 200mg twice daily for I week per month x 3 pulses; terbinafine - 250 mg/day for 12 weeks; or, fluconazole - 150 mg/wk until the abnormal-appearing nail plate has grown out, typically over a period of 9 to 18 months. For the 3 oral antifungal agents the more common adverse reactions pertain to the following systems, gastrointestinal (for example, nausea, gastrointestinal distress, diarrhoea, abdominal pain), cutaneous eruption, and CNS (for example, headache and malaise). Each of the new antifungal agents is more cost-effective than griseofulvin for the treatment of onychomycosis and is associated with high compliance, in part because of the shorter duration of therapy. The newer antifungal agents are generally well tolerated with drug interactions that are usually predictable.     

Synthesis and antifungal activities of novel 2-aminotetralin derivatives

Novel 2-aminotetralin derivatives were synthesized as antifungal agents. The 2-aminotetralin scaffold was chemically designed to mimic the tetrahydroisoquinoline ring of the lead molecule described before. Their antifungal activities were evaluated in vitro by measuring the minimal inhibitory concentrations (MICs). Compounds 10a, 12a, 12c, 13b, and 13d are more potent than fluconazole against seven testing human fungal pathogens. Compound 10b exhibits much higher antifungal activities against all of the four fluconazole-resistant clinic Candida albicans strains than the control drugs including amphotericin B, terbinafine, ketoconazole, and itraconazole. The mode of action of some compounds to the potential receptor lanosterol 14alpha-demethylase (CYP51) was investigated by molecular docking. The studies presented here provide a new structural type for the development of novel antifungal compounds. Furthermore, 10b was evaluated in vivo by a rat vaginal candidiasis model, and it was found that 10b significantly decreases the number of fungal colony counts.     

Resistance mechanisms in fluconazole-resistant Candida albicans isolates from vaginal candidiasis

Candida albicans is the most frequently identified yeast species causing mycotic vaginitis. A significant number of vaginal yeast isolates are resistant to azole antifungal agents in vitro. Here we investigated the molecular mechanisms of resistance in 22 randomly selected fluconazole-resistant vaginal C. albicans isolates. Twelve isolates in this collection were found to be cross-resistant to itraconazole and 15 to voriconazole. Most of them also displayed decreased susceptibility to terbinafine. Northern blot analyses revealed overexpression of the MDR1 gene in all isolates, which in some isolates was accompanied by elevated levels of CDR1/CDR2 and ERG11 expression. Sequence analysis of the polymerase chain reaction-amplified ERG11 gene of selected azole-resistant isolates identified D116E and V488I amino acid alterations in Erg11p that are known to be conserved in fluconazole-resistant strains. The results demonstrate that decreased susceptibilities of vaginal yeast isolates to clinically used azole derivatives are the result of a combination of several molecular mechanisms involving drug efflux and alterations in the structure or cellular amount of 14-alpha-lanosterol demethylase.     

5种不同用药方案治疗念珠菌性阴道炎的经济学评价

目的：探讨不同给药方案治疗念珠菌性阴道炎的经济学效果。方法：将189例念珠菌性阴道炎患者以随机抽样法分为5组,分别给予氟康唑片（A组）、伊曲康唑胶囊（B组）、克霉唑阴道片（C组）、氟康唑片＋克霉唑阴道片（D组）、伊曲康唑胶囊＋克霉唑阴道片（E组）,运用药物经济学方法进行成本-效果分析。结果：5组成本分别为15.57、51.18、13.60、29.17、64.78元;有效率分别为80%、89.5%、80.6%、97.5%、97.5%;成本-效果比分别为19.46、57.18、16.87、29.18、66.44;A、B、D、E组方案相对于C组方案的增量成本-效果比分别为-3.28、4.22、0.92、3.03。结论：治疗念珠菌性阴道炎的5种方案中,氟康唑片＋克霉唑阴道片方案较佳。     

假丝酵母菌属的耐药性分析

目的 了解我院深部真菌感染的种类和耐药特点,为合理使用抗真菌药物提供病原学依据.方法 对2009-2010年分离的假丝酵母菌属进行菌种分布和耐药性分析.结果 495株假丝酵母菌属占总分离病原菌(3027株)的比例为16.4％,其中白色假丝酵母菌397株,占80.2％;从呼吸道标本中分离出443株,占89.5％;白色假丝酵母菌对两性霉素B、5-氟胞嘧啶、氟康唑、伏立康唑、伊曲康唑的耐药率分别为0.3％ (1/397)、1.5％(6/397)、2.8％ (11/397)、4.8％( 19/397)、10.6％(42/397).结论 白色假丝酵母菌是真菌感染的主要病原菌,早期诊断和合理使用抗真菌药物是防治真菌感染的关键.     

Antimicrobial activity of clove oil and its potential in the treatment of vaginal candidiasis

In the present study, we evaluated antimicrobial activity of clove oil against a range of fungal pathogens including that responsible for urogenital infection. Clove oil was found to possess strong antifungal activity against opportunistic fungal pathogens such as Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus, etc. The oil was found to be extremely successful in the treatment of experimental murine vaginitis in model animals. On evaluating various formulations, topical administration of the liposomized clove oil was found to be most effective against treatment of vaginal candidiasis.