Prescrire Int. 2004 Feb;13(69):13-6.
(1) Amphotericin B is the antifungal drug of choice for the treatment of invasive aspergillosis, severe candidiasis and Fusarium infection. Voriconazole is an antifungal azole sold in France for oral and intravenous treatment of these infections. (2) In 391 patients with established or probable invasive aspergillosis, combined analysis of two trials comparing voriconazole (intravenously then orally) with conventional amphotericin (intravenously) showed that the 12-week survival rate was significantly higher with voriconazole (70.8% versus 57.9%). Unfortunately, these results are undermined by methodological flaws such as the lack of blinding, the very different intravenous treatment periods in the two groups, and subsequent oral treatment with different antifungal drugs. Voriconazole has not been compared with liposomal amphotericin B. (3) In the treatment of severe candidiasis, and severe Scedosporium and Fusarium infections, we only have the (favourable) results of non comparative trials in small numbers of patients refractory to other antifungal drugs. (4) The main adverse effects were visual disturbances, elevated hepatic enzyme levels, acute renal failure, and sometimes serious cutaneous reactions. It lengthens the QT interval and can cause torsades de pointes. It inhibits the cytochrome P450 isoenzymes CY3A4, CYP2C9 and CYP2C19, hence a high risk of potentially serious drug interactions. (5) Voriconazole can be given by mouth or by IV infusion, whereas liposomal amphotericin B must be given intravenously. (6) In practice, another more rigorous trial is needed to confirm the favourable results obtained with voriconazole in invasive aspergillosis. Voriconazole is the first-line treatment for severe Scedosporium infections, despite limited experience. It is a last resort for severe candidiasis and severe Fusarium infection.
（1）两性霉素B是治疗侵袭性曲霉病、严重念珠菌病和镰刀菌感染的首选抗真菌药物。伏立康唑是一种在法国销售的抗真菌唑类药物，用于口服和静脉治疗这些感染。（2）在391例确诊或疑似侵袭性曲霉病患者中，两项比较伏立康唑（先静脉给药后口服）与传统两性霉素（静脉给药）的试验联合分析显示，伏立康唑治疗的12周生存率显著更高（70.8%对57.9%）。不幸的是，这些结果因方法学缺陷而受到影响，如缺乏盲法、两组静脉治疗期差异很大以及随后使用不同抗真菌药物进行口服治疗。伏立康唑尚未与脂质体两性霉素B进行比较。（3）在治疗严重念珠菌病以及严重的尖端赛多孢菌和镰刀菌感染时，我们仅有在少数对其他抗真菌药物难治的患者中进行的非对照试验（有利）结果。（4）主要不良反应为视觉障碍、肝酶水平升高、急性肾衰竭，有时还有严重的皮肤反应。它会延长QT间期并可能导致尖端扭转型室速。它抑制细胞色素P450同工酶CY3A4、CYP2C9和CYP2C19，因此存在潜在严重药物相互作用的高风险。（5）伏立康唑可口服或静脉输注给药，而脂质体两性霉素B必须静脉给药。（6）在实际应用中，需要另一项更严格的试验来证实伏立康唑在侵袭性曲霉病中取得的有利结果。尽管经验有限，伏立康唑仍是严重尖端赛多孢菌感染的一线治疗药物。它是严重念珠菌病和严重镰刀菌感染的最后治疗手段。
