Kett Daniel H, Cubillos G Fernando
University of Miami Miller School of Medicine, Miami, FL 33101-6960, USA.
Int J Antimicrob Agents. 2008 Nov;32 Suppl 2:S99-S102. doi: 10.1016/S0924-8579(08)70008-6.
Echinocandins have emerged as important agents for the treatment of invasive candidiasis. Forthcoming guidelines are expected to recommend an echinocandin agent as initial primary therapy in patients who are severely ill and/or have risk factors for azole resistance. Amphotericin B deoxycholate and fluconazole should be considered for initial therapy in specific populations. The echinocandin, anidulafungin, has been shown to have higher response rates compared with fluconazole in patients with invasive candidiasis. Additionally, patients treated with anidulafungin compared with patients receiving fluconazole have exhibited a trend toward improved survival. The three echinocandins (anidulafungin, caspofungin and micafungin) offer proven efficacy along with excellent side-effect profiles. While these three drugs have important differences, the empirical selection of an echinocandin should be based on the specific patient population, including clinical status, the suspected pathogen, and the susceptibility pattern at the institution. Once the Candida species is identified and its susceptibility is determined, clinicians should consider step-down therapy to either fluconazole or voriconazole, with possible conversion from intravenous to oral therapy.
棘白菌素已成为治疗侵袭性念珠菌病的重要药物。即将出台的指南预计会推荐棘白菌素类药物作为重症患者和/或有唑类耐药危险因素患者的初始主要治疗药物。对于特定人群，两性霉素B去氧胆酸盐和氟康唑应作为初始治疗药物。在侵袭性念珠菌病患者中，棘白菌素类药物阿尼芬净已被证明比氟康唑有更高的有效率。此外，与接受氟康唑治疗的患者相比，接受阿尼芬净治疗的患者有生存改善的趋势。三种棘白菌素（阿尼芬净、卡泊芬净和米卡芬净）已被证明疗效确切，且副作用小。虽然这三种药物有重要差异，但棘白菌素类药物的经验性选择应基于特定患者群体，包括临床状况、疑似病原体以及所在机构的药敏模式。一旦确定念珠菌种类及其药敏情况，临床医生应考虑降阶梯治疗，改为使用氟康唑或伏立康唑，并可能从静脉治疗转为口服治疗。
