de Wet P M, Rode H, van Dyk A, Millar A J
Department of Paediatric Surgery, Institute of Child Health, Red Cross War Memorial Children's Hospital, Rondebosch, South Africa.
Int J Dermatol. 1999 Aug;38(8):618-22. doi: 10.1046/j.1365-4362.1999.00757.x.
To assess the efficacy and clinical outcome of 2% mupirocin in a polyethylene glycol base and nystatin cream as treatment regimens in diaper candidosis.
A prospective randomized comparative study.
In vitro. The susceptibility of 20 clinical isolates of Candida albicans to 2% mupirocin, nystatin, and five additional antifungal agents was evaluated using the Nathan agar-well diffusion assay. The minimum inhibitory concentration (MIC) of mupirocin against the Candida species was determined using a tube dilution method. In vivo. Twenty patients (mean age, 12 months; range, 1 month to 4 years) with moderate to severe Monilia diaper dermatitis either had mupirocin ointment or nystatin cream applied to the infected area every 8 h or after every diaper change for a period of 7 days. Microscopic examination of skin scrapings and mycologic and microbiological cultures were performed before treatment and daily for 7 days, and progress was clinically assessed.
In vitro. Topical mupirocin produced a greater zone of inhibition than nystatin cream, i.e. a mean of 27.2 mm (SD 1.55) compared with a mean of 17.3 mm (SD 1.08) for nystatin cream. MIC for mupirocin of 512 microg/mL in one case, 256 microg/mL in six cases, 200 microg/mL in 10 cases and 400 microg/mL in three cases were obtained for the 20 clinical isolates. C. albicans also displayed a universal sensitivity to mupirocin and nystatin. In vivo. Eradication of all Candida organisms was achieved within 2-6 days (mean, 2.6 days) in 10 patients receiving topical mupirocin therapy with rapid healing of the excoriated wounds (mean, 4.7 days). Both Gram-positive and Gram-negative bacteria were eradicated from the infected area within the trial period. Ten patients received topical nystatin cream and, in each case, Candida was successfully cleared within 5 days (mean, 2.8 days). Only three wounds were clinically healed within the trial period, however. The remaining seven wounds showed evidence of improved, but ongoing excoriated dermatitis and a heavy growth of polymicrobial organisms.
Both agents eradicated Candida, the major difference being the marked response of the diaper dermatitis to mupirocin. Mupirocin should be applied topically 3-4 times daily or with each diaper change and is an excellent antifungal agent.
评估聚乙二醇基质的2%莫匹罗星和制霉菌素乳膏作为尿布念珠菌病治疗方案的疗效和临床结果。
前瞻性随机对照研究。
体外实验。采用内森琼脂孔扩散法评估20株白色念珠菌临床分离株对2%莫匹罗星、制霉菌素和另外五种抗真菌药物的敏感性。采用试管稀释法测定莫匹罗星对念珠菌属的最低抑菌浓度（MIC）。体内实验。20例（平均年龄12个月；范围1个月至4岁）中度至重度念珠菌尿布皮炎患者，每8小时或每次更换尿布后在感染部位涂抹莫匹罗星软膏或制霉菌素乳膏，持续7天。在治疗前和治疗7天期间每天进行皮肤刮屑的显微镜检查以及真菌学和微生物学培养，并进行临床进展评估。
体外实验。局部应用莫匹罗星产生的抑菌圈比制霉菌素乳膏更大，即莫匹罗星平均为27.2 mm（标准差1.55），而制霉菌素乳膏平均为17.3 mm（标准差1.08）。20株临床分离株中，莫匹罗星的MIC在1例中为512 μg/mL，6例中为256 μg/mL，10例中为200 μg/mL，3例中为400 μg/mL。白色念珠菌对莫匹罗星和制霉菌素也均表现出普遍敏感性。体内实验。10例接受局部莫匹罗星治疗的患者在2 - 6天（平均2.6天）内实现了所有念珠菌的清除，擦伤创面快速愈合（平均4.7天）。在试验期间，感染部位的革兰氏阳性菌和革兰氏阴性菌均被清除。10例患者接受局部制霉菌素乳膏治疗，每例念珠菌均在5天内（平均2.8天）成功清除。然而，在试验期间只有3处创面实现了临床愈合。其余7处创面显示有改善迹象，但仍存在擦伤性皮炎且有大量多种微生物生长。
两种药物均能清除念珠菌，主要区别在于尿布皮炎对莫匹罗星的显著反应。莫匹罗星应每日局部应用3 - 4次或每次更换尿布时应用，是一种优良的抗真菌药物。
