Freeze-drying of itraconazole-loaded nanosphere suspensions: a feasibility study

The present study concerns the stabilization of the association of the new hydrophobic triazole derivative itraconazole within poly-ϵ-caprolactone-nanospheres by means of freeze-drying. We have investigated the freeze-drying of nanospheres, and especially the cryopreservation conditions, with the help of differential scanning calorimetry and zeta potential measurements. Five commonly used cryoprotective agents were evaluated (glucose, sucrose, trehalose, dextran, mannitol at 0, 5, 10, 20, and 30% [w/v]) after freeze-thawing and freeze-drying. The addition of carbohydrates led to a partial protection of the colloidal suspension, with leakage of 30% of itraconazole under the best cryopreservation conditions (10% of glucose or sucrose). Zeta potential measurements revealed that the main destabilization mechanism during freeze-drying was surface modifications of the nanospheres, and particularly drug desorption. Therefore, the hydrophilic surfactant adsorbed at the surface of the nanospheres played an important role in the cryopreservation. Replacing the commonly used non ionic surfactant PLURONIC®PE F68 by the anionic surfactant sodium deoxycholate resulted in a complete stabilization of itraconazole-loaded nanospheres after freeze-drying, with no drug desorption, in the presence of 10% sucrose, but not in the presence of glucose. As shown by thermal analysis, PLURONIC®PE F68 may crystallize during freezing, which could lead to surface modifications and drug desorption, whereas sodium deoxycholate may not. Moreover, the Tg′ of glucose-containing suspensions is 10°C lower than Tg′ of sucrose-containing suspensions, which may explain the shrinkage of the cake observed in the case of glucose and the homogeneous appearance of the dried product in the case of sucrose. © 1996 Wiley-Liss, Inc.     

烟曲霉的微管蛋白基因鉴定及唑类抗真菌药物的耐药性研究

目的建立烟曲霉临床分离菌株的微管蛋白基因鉴定方法,并分析烟曲霉对唑类抗真菌药物的耐药性。方法对表型鉴定为烟曲霉的菌株,采用十六烷基三甲基溴化铵(CTAB)方法提取烟曲霉菌株DNA,并采用对微管蛋白基因进行PCR扩增和测序的方法对烟曲霉菌株进行分子生物学鉴定,采用琼脂稀释法检测烟曲霉菌株对伊曲康唑和伏立康唑的耐药性。结果 91株临床分离株表型鉴定为烟曲霉,这些菌株在35℃和48℃生长。其中88株(96.70%)经微管蛋白基因鉴定为烟曲霉。87株烟曲霉菌株对4μg/mL伊曲康唑和1μg/mL伏立康唑敏感,检出1株对4μg/mL伊曲康唑和1μg/mL伏立康唑耐药菌株。结论微管蛋白基因鉴定方法可以对烟曲霉进行准确鉴定。     

Subcutaneous zygomycosis: report of 10 cases from two institutions in North India

Background Subcutaneous zygomycosis is an uncommon condition observed in tropics. Few series have been published, particularly from the northern regions of India. Objectives The aim of this study was to describe clinical, investigative and therapeutic details in subcutaneous zygomycosis observed in two teaching hospitals in Delhi. Patients and methods Ten patients seen over a period of 10 years (1999–2009) form the material for this report. Results There were four children and six adults. In four children, the presentation was a subcutaneous localized mass or gradually spreading plaque. In the others, it was observed over nasal region of face, spreading inward into mucosal sites and paranasal sinuses, and outward to the contiguous areas. Regional lymphadenopathy was present in two with facial lesions. Majority showed a granulomatous infiltrate with admixture of other cells, mainly eosinophils. Aseptate or poorly septate hyphae were observed in seven. In one patient in whom no hyphae were observed, there was dense perivascular inflammation. Organisms were cultured from four patients, Basidiobolus ranarum in two and Syncephalastrum racemosum in two. The main therapy used was a saturated solution of potassium iodide (KI). Four received only KI of which two attained cure after 3 months and 9 months respectively, and the other two showed signs of regression. In one boy subsidence was associated with reduced circumference of thigh. Ketoconazole or itraconazole was given with KI to hasten regression when response was slow or there were side‐effects to KI. Conclusion Awareness and early recognition will prevent disfigurement produced by advanced disease, misdiagnosis and unnecessary surgical intervention.     

伊曲康唑分散片在健康人体的生物等效性

目的研究伊曲康唑分散片和伊曲康唑胶囊(抗真菌药)在健康人体的生物等效性。方法采用两制剂双周期双交叉随机自身对照试验设计,20名男性健康志愿者分别口服伊曲康唑胶囊0.2g和伊曲康唑分散片0.2g(参比制剂和受试制剂),用HPLC法测定给药后不同时刻伊曲康唑的血药浓度,用DASVer1.0计算药代动力学参数。结果受试制剂与参比制剂的伊曲康唑主要药代动力学参数:t1/2分别为(20.89±4.58)、(21.05±4.37)h,Cmax分别为(244.3±69.8)、(240.2±66.3)ng·mL-1,tmax分别为(4.05±0.91)、(3.98±1.12)h,AUC0-72分别为(2786.5±670.3)、(2802.8±612.3)ng·h·mL-1,受试制剂与参比制剂相比平均相对生物利用度为(96.8±8.7)%。结论2种制剂在人体内具有生物等效性。     

Management protocols of Allergic Fungal Sinusitis

Controversy surrounds the appropriate surgical approach and the appropriate medical therapy for Allergic Fungal Sinusitis. The present prospective study aims to assess the impact of these factors on the treatment outcome of Allergic Fungal Sinusitis. In the present study 34 cases with AFS were randomized into one of 3 methods of post operative therapy i.e. systemic itraconazole (group A, n=11), topical steroids (group B, n=12) and nasal alkaline douches only (group C, n=11). Outcome was assessed at 6 months post-operative by the Kupferberg grading system for assessment of nasal and sinus mucosa. Grade ‘3’ mucosal disease was defined as recurrence. Complete pre-operative opacification of sphenoid and frontal sinus was a predictor of poorer outcome. Postoperative systemic itraconazole therapy demonstrated a trend towards a better outcome but was not statistically significant. Larger trials are required to conclusively evaluate the merit of various post-operative treatment regimens for AFS.     

氟康唑和伊曲康唑先后应用致麻疹样疹

1例78岁女性患者因脑出血、右侧中枢性偏瘫、肺部感染住院治疗。入院第21天，尿、便中检出霉菌孢子和菌丝，考虑霉菌感染。给予氟康唑静脉滴注治疗，首日0．4g／d，以后0．2g／d。3d后患者胸腹部出现红色斑疹，轻度瘙痒。停用氟康唑，改用伊曲康唑0．25g，2：L／d静脉滴注。治疗2d后，患者躯干和四肢红色斑疹继续增多，瘙痒显著。停用伊曲康唑，改用大蒜素静脉滴注并口服氯苯那敏抗过敏治疗，5d后皮疹基本消退。     

HPLC测定人血浆中伊曲康唑的浓度及生物等效性研究

 目的建立HPLC测定伊曲康唑人血浆中浓度和评价伊曲康唑分散片的生物等效性。方法18名健康志愿者单剂量po分散片及胶囊2种伊曲康唑制剂(各含伊曲康唑0.1g)后测定不同时间血药浓度,采用Kromail C₁₈色谱柱(4.6mm×250mm,5μm),以乙腈-水(78∶22)为流动相,流速1.0mL·min^-1;检测波长263nm,检测器灵敏度0.01AUFS,20μL定量环进样。结果受试制剂伊曲康唑分散片和参比制剂伊曲康唑胶囊中伊曲康唑的主要药动学参数:达峰时间为(3.89±0.32)和(3.94±0.24)h,达峰时药物浓度为(1601.12±151.03)和(1678.74±200.37)μg·L^-1,消除相半衰期为(16.50±1.80)和(16.43±1.35)h,药-时曲线下面积AUC_0-72为(21194.89±2604.04)和(21795.72±2657.52)μg·h·L^-1,AUC_0-∞为(22418.87±2921.60)和(23060.62±2865.28)μg·h·L^-1。结论2种伊曲康唑制剂具有生物等效性。     

伊曲康唑自乳化释药系统的处方研究

 目的研究伊曲康唑自乳化给药系统(ITZ-SEDDS)的处方工艺。方法通过溶解度实验?处方配伍和伪三相图的绘制,以自乳化时间?色泽和粒径的大小为指标,筛选油相、表面活性剂、助表面活性剂的最佳搭配和处方配比。并对ITZ-SEDDS的理化性质和体外溶出度进行了测定。结果伊曲康唑自乳化最终优化处方为:Maisine 35-1-Cremophor EL-Transcutol P=25∶30∶45。ITZ-SEDDS的粒径为162.5 nm,自乳化时间<1 min,ITZ-SEDDS在人工肠液中2 h累积溶出百分率为90.9%,是原药(0.52%)的174.8倍,市售胶囊(10.1%)的9.0倍。结论所制备的ITZ-SEDDS达到了设计要求,为ITZ的新制剂开发提供了实验依据。     

Experimental aspergillosis in guinea pigs: influence of itraconazole on fungaemia and invasive fungal growth

Summary. The guinea pig model of experimental aspergillosis was used to evaluate the efficacy of itraconazole 2.5 and 5 mg kg^-1 in preventing the invasive phase of the disease when animals were already loaded with Aspergillus conidia. Evaluations were made by recording the survival rates, culturing fragments of nine organs, examining seven organs by means of histochemistry and immunohistochemistry (mAb EB-Al to Aspergillus galactomannan) and by serological titration of galactomannan. The data indicate that itraconazole is highly effective in preventing true invasive aspergillosis. Serological evaluations of antigenaemia suggest that low titres may only reflect fungaemia, while titres of 1:8 and above are suggestive of invasive disease.
Zusammenfassung. Das Meerschweinchen-Modell der experimentellen Aspergillose wurde eingesetzt, um die Wirkung von 2,5 mg und 5 mg kg^-1 Itraconazol zur Prävention der invasiven Krankheitsphase zu bewerten, wenn die Versuchstiere bereits mit Aspergillus -Konidien beladen sind. Die Bewertung stützt sich auf die Überlebensrate, auf Pilzkulturen aus neun verschiedenen Organen, auf histochemische und immunhistochemische Untersuchungen von sieben Organen mittels MOB EB-Al-Antikörpern gegen Aspergillus -Galactomannan sowie auf die Serotitration dieses Antigens. Die Ergebnisse belegen die hohe Wirksamkeit des Itraconazols in der Prävention der echt invasiven Aspergillose. Antigen-Titrationen im Serum sprechen dafür, daß geringe Titer lediglich das Fungämie-Stadium widerspiegeln, während Antigentiter ≥ 1:8 eine invasive Aspergillose belegen.     

Kontroversen bei der Standardisierung der Empfindlichkeits-prüfung von Hefen gegen Azol-Antimyotika

Zusammenfassung. Die unterschiedlichen physikalisch-chemischen Eigenschaften der therapeutisch ein-gesetzten Azol-Antimykotika erfordern ein Testverfahren, welches diesen gerecht wird. Fluconazol kann innerhalb der Gruppe der Azol-Antimykotika aufgrund seiner Hydrophilie als unproblematische Testsubstanz angesehen werden. Die extreme Hydrophobizität des Itraconazols läßt eine Übertragung der Testbedingungen für Fluconazol auf die Itraconazoltestung nicht zu. Die aktuellen Empfehlungen des NCCLS werden dieser Problematik nicht gerecht. Deshalb ist es notwendig, einen einheitlichen Standard für die In-vitro-Testung der Gruppe der Azol-Antimykotika festzulegen.
Summary. Due to the different physical-chemical conditions of the therapeutical azoles it is necessary to choose an adequate testing procedure. In the group of azoles caused by its hydrophilia fluconazole susceptibility testing can be handled easily. However it is not possible to take the same test conditions for itraconazole as for fluconazole due to the extreme high hydrophobicity of itraconazole. The current recommendations of NCCLS should be considering these problems. Therefore it is necessary to standardize susceptibility testing for all azoles possible.