Lewis James S
Department of Pharmacy, University Health System, San Antonio, Texas 78229, USA.
Med Mycol. 2009;47 Suppl 1:S376-81. doi: 10.1080/13693780802603698. Epub 2009 Mar 18.
Echinocandins represent a safe and well tolerated option for the therapy of invasive aspergillosis in patients who are unable to tolerate other agents or have refractory disease. In vitro and animal model data provide useful insights into the activity, appropriate dose, and potential role of these agents in invasive aspergillosis. These studies reveal a potentially concerning lack of tissue sterilization when echinocandins are used as monotherapy but clearly show improved survival with increasing doses. Furthermore pharmacodynamic studies suggest that echinocandin doses currently in widespread clinical use may optimize outcomes in invasive aspergillosis. A paucity of clinical data exists examining these agents as monotherapy for invasive aspergillosis and virtually no clinical data exists for using these agents as primary therapy. Further data examining the role of echinocandin monotherapy for invasive aspergillosis is unlikely to be forthcoming in the foreseeable future due to several factors including the aforementioned issues, the relatively small number patients with this infection, and the belief that these agents are potentially best used as part of combination therapy regimens for invasive aspergillosis.
对于无法耐受其他药物或患有难治性疾病的侵袭性曲霉病患者，棘白菌素是一种安全且耐受性良好的治疗选择。体外和动物模型数据为这些药物在侵袭性曲霉病中的活性、合适剂量及潜在作用提供了有用的见解。这些研究表明，当棘白菌素作为单一疗法使用时，可能存在令人担忧的组织杀菌不足问题，但清楚显示随着剂量增加生存率有所提高。此外，药效学研究表明，目前广泛临床使用的棘白菌素剂量可能使侵袭性曲霉病的治疗效果达到最佳。缺乏将这些药物作为侵袭性曲霉病单一疗法的临床数据，实际上也没有将这些药物作为一线治疗的临床数据。由于包括上述问题、感染该疾病的患者相对较少以及认为这些药物可能最适合作为侵袭性曲霉病联合治疗方案的一部分等多种因素，在可预见的未来不太可能获得更多关于棘白菌素单一疗法在侵袭性曲霉病中作用的进一步数据。
