复方两性霉素B溶液治疗耳真菌病临床疗效研究

目的：观察两性霉素B联合利福平复方溶液治疗耳真菌病的临床疗效，进而探讨有效的治疗方法。方法：（1）运用棋盘式微量液基稀释法测定两性霉素B联合利福平对白色念珠菌标准菌株（编号ATCC90028）的体外最低抑菌浓度（MIC）值，在此基础上计算部分抑菌浓度指数（FIC）；依据FIC值判断两药联用是否有协同作用；（2）经真菌培养及鉴定确定为耳真菌病的60例患者中，根据临床症状与体征轻重的得分标准，随机分为3组，分别用两性霉素B、两性霉素B联合利福平复方溶液和3%水杨酸酒精滴耳液外耳道局部治疗1周、2周后，观察3组愈显率；并随访1年。结果：（1）两药联用的FIC指数小于0.5；（2）3组愈显率比较，第1周：两性霉素B联合利福平复方溶液组愈显率最高，较其他2组有统计学意义（P<0.05），第2周：两性霉素B和利福平组与两性霉素B组愈显率相比无统计学意义（P>0.05），以上2组分别与3%水杨酸酒精滴耳液组愈显率相比有统计学意义（P<0.05）。随访一年，水杨酸酒精滴耳液组复发率比其他2组高，差异有统计学意义（P<0.05）。结论：（1）两性霉素B联合利福平对真菌有协同作用；（2）两性霉素B联合利福平复方溶液外用制剂是治疗耳真菌病较理想的外用药物，且具有便于取材、配制简单、使用方便、起效快等优点，值得向基层医院推广。

Clinical effects of amphotericin B combined with rifampicin against otomycosis

OBJECTIVE To estimate clinical effects of amphotericin B combined with rifampicin against otomycosis. METHODS MIC value of amphotericin B combined with rifampicin against candida albicans (ATCC90028) was determined via broth microdilution and fractional inhibitory concentration (FIC) was calculated, and synergistic effect of the drug combination was also observed. Sixty subjeects with otomycosis were randomly divided into amphotericin B, amphotericin B combined rifampicin group and 3% alcohol salicylic acid ear drop groups based on clinical symptoms and physical signs. Clinical efficacy was observed at allocated time points (7 days and 14 days), and the patients were followed up for one year. RESULTS MIC of combined drug was less than 0.5. The clinical efficacy of drug combination against otomycosis was more evident than other groups in the firt week (P<0.05). No significant difference was observed between drug combination group and other groups in the second week (P>0.05). One year later, 3% salicylic acid ear drop showed a higher recurrence rate than other two groups (P<0.05). CONCLUSION Clinical efficacy of amphotericin B combined with rifampicin against otomycosis was more obvious than those of the other two groups. Amphotericin B combined with rifampicin may be a novel therapeutic alternative against otomycosis.