Lewis Russell E
Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, Texas 77030, USA.
Pharmacotherapy. 2006 Jun;26(6 Pt 2):61S-67S. doi: 10.1592/phco.26.6part2.61S.
The availability of new antifungal agents with novel mechanisms of action and improved tolerability has widened the possibilities for combination therapy for difficult-to-treat opportunistic mycoses. However, empiricism largely governs this therapy, especially in patients with invasive mould infections for whom there is a dire need to improve outcomes. Because of difficulties associated with the design and conduct of clinical trials of combination therapy for opportunistic mycoses, most studies are still performed in the laboratory or in animal models. Methods to assess combined antifungal effects in vitro and in animals are poorly standardized, and little evidence suggests that the data generated from these studies are relevant to treating patients. Even without solid evidence to support routine combination therapy, certain principles can guide its use in select patients.
具有新型作用机制和更好耐受性的新型抗真菌药物的出现，拓宽了难治性机会性真菌病联合治疗的可能性。然而，经验主义在很大程度上主导着这种治疗方法，尤其是在侵袭性霉菌感染患者中，迫切需要改善治疗效果。由于机会性真菌病联合治疗临床试验的设计和实施存在困难，大多数研究仍在实验室或动物模型中进行。体外和动物体内联合抗真菌效果的评估方法标准化程度很低，而且几乎没有证据表明这些研究产生的数据与治疗患者相关。即使没有确凿证据支持常规联合治疗，某些原则也可以指导其在特定患者中的应用。
