Najvar L K, Bocanegra R, Wiederhold N P, Lambros C, Najarian N, Patterson T F, Graybill J R
Division of Infectious Diseases, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Clin Microbiol Infect. 2008 Jun;14(6):595-600. doi: 10.1111/j.1469-0691.2008.01994.x. Epub 2008 Apr 5.
Extended interval dosing of the echinocandins has been suggested as a potential strategy to overcome the need for daily intravenous administration. This study evaluated the therapeutic and prophylactic efficacy of single doses of aminocandin, a new echinocandin in preclinical development, in a murine model of invasive candidiasis. For therapy, groups of mice were infected with Candida albicans, followed by a single dose of aminocandin (1-15 mg/kg) or placebo (mannitol 5% w/v) administered 1 day after inoculation. As prophylaxis, mice were given a single dose (5 or 30 mg/kg) of aminocandin, caspofungin, or placebo at increasing intervals between dose and inoculation. In both treatment and prophylaxis studies, survival was assessed at 21 days post-inoculation. The reduction in fungal burden was assessed in kidney tissue on day 8 post-inoculation. For treatment, single doses of aminocandin of >/=2.5 mg/kg prolonged survival significantly. In addition, the two doses evaluated for reductions in fungal burden (5 and 15 mg/kg) revealed fungicidal activity. As prophylaxis, both aminocandin and caspofungin 5 and 30 mg/kg prolonged survival when given 7 days before inoculation. Aminocandin and caspofungin 30 mg/kg were both able to prolong survival when the interval between dose and inoculation was increased to 10 days. When this interval was extended to 14 days, only aminocandin 30 mg/kg prolonged survival and reduced fungal burden. These results demonstrate that single doses of aminocandin are effective as treatment and prophylaxis, and suggest that extended interval dosing may be a useful strategy for treating invasive candidiasis.
已有人提出延长棘白菌素的给药间隔时间,作为一种可能的策略来解决每日静脉给药的需求。本研究在侵袭性念珠菌病小鼠模型中评估了单剂量氨曲南(一种处于临床前开发阶段的新型棘白菌素)的治疗和预防效果。对于治疗,将小鼠分组感染白色念珠菌,接种后1天给予单剂量氨曲南(1 - 15 mg/kg)或安慰剂(5% w/v甘露醇)。作为预防措施,在接种前不同间隔时间给予小鼠单剂量(5或30 mg/kg)的氨曲南、卡泊芬净或安慰剂。在治疗和预防研究中,均在接种后21天评估存活率。在接种后第8天评估肾脏组织中的真菌负荷减少情况。对于治疗,单剂量≥2.5 mg/kg的氨曲南显著延长了存活时间。此外,评估的两个用于减少真菌负荷的剂量(5和15 mg/kg)显示出杀真菌活性。作为预防措施,接种前7天给予5和30 mg/kg的氨曲南和卡泊芬净均延长了存活时间。当剂量与接种之间的间隔增加到10天时,30 mg/kg的氨曲南和卡泊芬净均能够延长存活时间。当此间隔延长至14天时,只有30 mg/kg的氨曲南延长了存活时间并降低了真菌负荷。这些结果表明单剂量氨曲南作为治疗和预防有效,并提示延长给药间隔时间可能是治疗侵袭性念珠菌病的一种有用策略。