伏立康唑联合两性霉素B治疗曲霉菌性脓胸1例报道

目的 分析1例曲霉菌性脓胸合并支气管胸膜瘘患者的诊治情况,为临床诊治提供参考.方法 使用伏立康唑联合两性霉素B治疗1例曲霉菌性脓胸合并支气管胸膜瘘患者.结果 伏立康唑静脉使用69 d、口服10d,与两性霉素B联合使用53 d,脓胸好转.结论 全身使用伏立康唑联合两性霉素B胸腔灌注是安全、可靠的,也取得了良好的治疗效果.     

Comparison of the Efficacy and Tolerability of Amoxycillin/Clavulanic Acid 875mg b.i.d. with Cefuroxime 500mg b.i.d. in the Treatment of Chronic and Acute Exacerbation of Chronic Sinusitis in Adults

Abstract

The efficacy and safety of amoxycillin/clavulanic acid (AMX/CA) (875/125mg b.i.d. for 14 days) were compared with that of cefuroxime axetil (500mg b.i.d. for 14 days) in a multicenter, open, parallel-group, randomized clinical trial in 206 adults with chronic or acute exacerbation of chronic sinusitis. Clinical response was similar, with 95% of AMX/CA-, and 88% of cefuroxime-treated, clinically evaluable patients cured (95% confidence interval; -0.6% to +15%). In bacteriologically evaluable patients, cure rates, defined as eradication of the original pathogen with or without re-colonization with non-pathogenic flora, were also similar, with 65% of AMX/CA- and 68% of cefuroximetreated patients cured (95% confidence interval; ?18% to +15%). However, clinical relapse was significantly higher in the cefuroxime group: 7% (7/89) of clinically evaluable patients, compared with 0% (0/98) in the AMX/CA (p=0.0049) group. A similar incidence of possible or definite adverse events related to the study drug was reported for both treatments (AMX/CA 4.4%, cefuroxime 4.3%), the most frequent being diarrhea. Four adverse events were recorded as serious or life-threatening with only one considered related to the study drug (urticaria, cefuroxime). AMX/CA 875/125mg b.i.d. for 14 days is as effective and well tolerated as cefuroxime axetil 500mg b.i.d. for 14 days in the treatment of chronic, or acute exacerbation of chronic sinusitis, but is associated with a significantly lower clinical relapse rate.     

Superior Vena Cava Syndrome Caused By Chemotherapy-Induced Fibrosis

Abstract

We report a case of a 51-year old man with small cell lung cancer who developed superior vena cava syndrome due to obstruction of the superior vena cava at the junction of the brachiocephalic vein by a fibrotic band, 2 months after completing six cycles of chemotherapy with cisplatin and etoposid. Superior vena cava syndrome caused by chemotherapy-induced pulmonary fibrosis should be kept in mind during follow-up.     

伏立康唑、氟康唑和两性霉素B体内抗克柔念珠菌活性的比较研究

目的比较伏立康唑、氟康唑和两性霉素B在体内对克柔念珠菌的抗真菌活性。方法在克柔念珠菌深部感染的免疫抑制豚鼠模型上,对感染豚鼠分组给予口服伏立康唑10mg/kg,2次/d;伏立康唑5mg/kg,2次/d;氟康唑20mg/kg,2次/d;两性霉素B1mg/kg隔日1次腹腔注射;安慰剂对照组给予生理盐水0.5ml,2次/d口服。均连续7天。观察比较各组的死亡率及脏器组织载菌量。结果安慰剂对照组豚鼠的所有受检脏器都受到了严重的感染。5个处理组中,伏立康唑10mg组的组织载菌量与死亡率(0%)均最低;与对照组相比,该方案使念珠菌在肺、肝、肾、脑四种脏器中的组织载菌量都减少了约99%(P<0.01)。伏立康唑5mg组的组织载菌量和豚鼠死亡率均与安慰剂对照组相近,无显著性差异。氟康唑组的组织载菌量与对照组相近,其死亡率(40%)仅略低于对照组,两组间无显著性差异(P>0.05)。伏立康唑10mg组与两性霉素B组相比,在组织载菌量和死亡率方面均较为接近,较之安慰剂对照组均有显著差异(P<0.01)。结论伏立康唑在免疫抑制豚鼠体内能有效地抑制感染脏器中克柔念珠菌的生长,其作用明显优于氟康唑,与两性霉素B作用相近,但两性霉素B常有严重的不良反应。伏立康唑在体内可能以剂量依赖的形式显示其抗真菌活性。     

播散性马尔尼菲青霉菌感染二例报道并文献复习

目的 探讨儿童播散性马尔尼菲青霉菌感染的实验室检查、临床表现和治疗策略.方法报道分析播散性马尔尼菲青霉菌感染患儿临床表现,病原学检查,影像学资料和治疗结果.结果病例1,男,1岁,发热、咳嗽1个月;骨髓、血培养:马尔尼菲青霉菌;伏立康唑治疗后好转.病例2,女,8岁,发热1个月,烦躁1d;血培养:马尔尼菲青霉菌.结论儿童播散性马尔尼菲青霉菌感染可累及中枢神经系统.伏立康唑可作为静脉-口服序贯治疗策略的选择.     

Comparison of results of fluconazole and voriconazole disk diffusion testing for Candida spp. with results from a central reference laboratory in the ARTEMIS DISK Global Antifungal Surveillance Program

The accuracy of antifungal susceptibility testing is important for reliable resistance surveillance and for the clinical management of patients with serious infections due to Candida spp. Our primary objective was to compare the results of fluconazole and voriconazole disk diffusion testing of 3227 Candida spp. performed by 47 centers participating in the ARTEMIS program with disk diffusion and MIC results obtained by the central reference laboratory. The overall categoric agreement between participant disk diffusion test results and reference MIC results was 87% for fluconazole and 95.2% for voriconazole. Likewise good agreement was observed between participant disk diffusion test results and reference laboratory disk diffusion test results, with an agreement of 90.5%, 1% very major error (VME), and 3.4% major error (ME) for fluconazole and 94.2%, 1.1% VME, and 2.5% ME for voriconazole. The disk diffusion test was reliable for detecting those isolates of Candida spp. that were characterized as resistant to fluconazole and voriconazole by MIC testing. External quality assurance data obtained by surveillance programs such as the ARTEMIS Global Antifungal Surveillance Program ensure the generation of useful surveillance data and result in the continued improvement of antifungal susceptibility testing protocols.     

In vitro antifungal combination effects of micafungin with fluconazole, voriconazole, amphotericin B, and flucytosine against clinical isolates of Candida species

Micafungin (MCFG) is an echinocandin antifungal agent that exhibits potent activity against most species of Candida and Aspergillus. We investigated the in vitro antifungal combination effects of MCFG with four other antifungal agents — fluconazole (FLCZ), voriconazole (VRCZ), amphotericin B, and flucytosine — against clinical isolates of 54 Candida spp. by checkerboard analysis. The synergistic antifungal effects of MCFG-FLCZ and MCFG-VRCZ were 11% and 15%, respectively, and the latter displayed a synergistic activity of 63% against Candida glabrata. Antagonism was not observed in any of the combinations tested.     

Voriconazole and the liver

Voriconazole is an azole useful for the prophylaxis and the treatment of aspergillosis and other fungal infections in immunosuppressed subjects, as those found in aplasia after aggressive polychemotherapy treatments, after hematopoietic stem cell, liver or lung transplantation. Its administration in therapeutic doses lead to extremely varied serum levels from patient to patient and even to the same patient. The explanations are varied: nonlinearpharmacokinetics, certain patient-related factors, including genetic polymorphisms in the cytochrome P450 2C19 gene, the kidney and liver function, simultaneous administration with other drugs metabolised by the same cytochrome. It is recommended to maintain the serum concentrations of voriconazole between 1.5 and 4 μg/m L. At lower values its efficacy decreases and at higher values the risk of neurological toxicity increases. Even at these concentrations it is not excluded the possible appearance of a variety of toxic effects, including on the liver, manifested by cholestasis, hepatocytolisis, or their combination. It is recommended to monitor the clinical and laboratory evolution of all patients treated with voriconazole, and of the serum levels of the drug of those who belong to risk groups, even if there is still no consensus on this issue, given the lack of correlation between the serum level and the occurrence of adverse effects in many patients.     

伏立康唑个体化用药指南计划书

摘 要为促进伏立康唑在临床合理使用,亟需制定指南进行规范和指导。本指南计划书将主要介绍该指南的制作方法和过程：如临床问题和结局指标的收集及确定,证据的获取和评价及推荐意见的共识等。     

《中国伏立康唑个体化用药指南》推荐意见的外审

摘 要 背景：《中国伏立康唑个体化用药指南》是基于GRADE系统制定的个体化用药指南。指南共识专家组和指导委员会分别于2016年7月1日和5日正式举行了推荐意见共识会议和审定会议,与会专家达成共识并批准了27 条推荐意见。目的：了解《中国伏立康唑个体化用药指南》推荐意见的科学性和可行性,以进一步修订推荐意见。方法：针对27 条推荐意见的赞成程度、表述清楚程度和可行程度,指南制定工作组以纸质问卷的形式开展外审工作,征求一线医务工作者（临床医师、临床药师）和患者代表的意见和建议,根据外审结果,由指南指导委员会对推荐意见进行修订和完善。 结果：来自4 家医院、7 个科室的12 名临床医师、8 名临床药师、1 名患者代表参与了外审工作。对推荐意见的总体赞成程度为80%,总体表述清楚程度为91%,总体可行程度为80%。所有推荐意见赞成程度、表述清楚程度和可行程度均超过30%。此外,共收到86 条主观建议。根据外审结果,指南指导委员会重新修订了14条（52%）推荐意见：修改了5条推荐意见的主体内容;修改了9 条推荐意见的表述,并将其中2 条推荐意见合并为1 条。最终指南包含了26 条推荐意见。结论：本次外审工作对《中国伏立康唑个体化用药指南》推荐意见的最终形成提供了依据,进一步完善了所有推荐意见的科学性、明晰性和可行性。