Ullmann Andrew J, Cornely Oliver A
Third Department of Internal Medicine, Klinikum der Johannes Gutenberg-Universität, Mainz, Germany.
Curr Opin Infect Dis. 2006 Dec;19(6):571-6. doi: 10.1097/QCO.0b013e3280108e45.
New broader spectrum antifungal agents with favorable safety profiles have been available for the last 15 years making prophylaxis feasible. The purpose of this article is to review recent studies in patient populations at high risk for invasive fungal infections.
Itraconazole, lipid formulations of amphotericin B, posaconazole, caspofungin and micafungin have been utilized for prophylaxis in different immunocompromised host settings. Itraconazole and caspofungin remain an option especially in patients with hematological diseases. Low dose liposomal amphotericin B shows a lower morbidity rate in patients treated for acute myeloid leukemia. Posaconazole demonstrated survival benefits in this setting although data have only been presented at an international meeting. In the transplantation setting, micafungin was superior to fluconazole during the early neutropenic phase and posaconazole was superior to fluconazole in preventing invasive aspergillosis in hematopoietic transplant recipients treated for graft-versus-host disease. Results from the latter study have thus far only been presented in abstract form.
Prophylaxis should only be given to a high-risk population. Results of studies should demonstrate morbidity and mortality advantages. The new generation of azoles and echinocandins have a favorable safety and drug interaction profile and appear advantageous in specific settings of immunosuppression. Pending full publication, posaconazole appears to be an appropriate agent for prophylaxis in acute myeloid leukemia patients or patients treated for graft-versus-host disease. Micafungin is superior to fluconazole in the neutropenic phase of hematopoietic transplantation.
在过去15年里，已有安全性良好的新型广谱抗真菌药物，使得预防成为可能。本文旨在综述侵袭性真菌感染高危患者群体的近期研究。
伊曲康唑、两性霉素B脂质体、泊沙康唑、卡泊芬净和米卡芬净已用于不同免疫功能低下宿主环境的预防。伊曲康唑和卡泊芬净仍是一种选择，尤其是在血液系统疾病患者中。低剂量脂质体两性霉素B在治疗急性髓系白血病的患者中发病率较低。泊沙康唑在这种情况下显示出生存获益，尽管数据仅在一次国际会议上公布。在移植环境中，米卡芬净在中性粒细胞减少早期优于氟康唑，泊沙康唑在预防移植物抗宿主病的造血移植受者侵袭性曲霉病方面优于氟康唑。后一项研究的结果迄今为止仅以摘要形式公布。
预防措施应仅用于高危人群。研究结果应显示出发病率和死亡率方面的优势。新一代唑类和棘白菌素类药物具有良好的安全性和药物相互作用特征，在特定免疫抑制环境中似乎具有优势。在完整发表之前，泊沙康唑似乎是急性髓系白血病患者或接受移植物抗宿主病治疗患者预防的合适药物。米卡芬净在造血移植中性粒细胞减少期优于氟康唑。
