Wada Hideho, Tanabe Satoko, Ichikawa Kazuko, Sano Fuminori, Kubo Yasutaka, Matsuhashi Yoshiko, Nakanishi Hidekazu, Tasaka Taizo, Sugihara Takashi
Division of Hematology, Department of Medicine, Kawasaki Medical School.
Jpn J Antibiot. 2009 Feb;62(1):17-25.
There have been some reports on the efficacy and tolerability of itraconazole (ITCZ) as prophylaxis for fungal infection after HSCT, and guidelines recommend itraconazole as a standard drug for prophylaxis of fungal infection in HSCT patients. However, it is not uncommon for patients undergoing HSCT to develop anorexia and taste disturbance. There are some cases where the bitter taste of ITCZ oral solution leads to interruption of administration because the patient refuses to take this medicine. Therefore, we investigated the clinical utility and influence on continuing treatment adherence by jellification of ITCZ. Compared with ITCZ oral solution, jellified ITCZ was extremely easy for most patients to take, and it was suggested that jellified ITCZ can make it easier for patients to continue treatment if they have difficulty with administration because of the bitter taste of ITCZ oral solution. Furthermore, it was confirmed that the plasma concentration of ITCZ was suitable for prophylaxis even with jellified ITCZ. This also suggested that the efficacy of ITCZ would be maintained by using jellified formation. For long-term antifungal therapy in patients with a high risk of fungal infection such as those having HSCT, it is very important for successful prophylaxis to maintain good adherence.
关于伊曲康唑（ITCZ）作为异基因造血干细胞移植（HSCT）后真菌感染预防用药的疗效和耐受性已有一些报道，指南推荐伊曲康唑作为HSCT患者真菌感染预防的标准药物。然而，接受HSCT的患者出现厌食和味觉障碍并不少见。在某些情况下，ITCZ口服溶液的苦味会导致患者拒绝服药，从而中断给药。因此，我们研究了ITCZ凝胶化后的临床实用性及其对持续治疗依从性的影响。与ITCZ口服溶液相比，大多数患者服用ITCZ凝胶极其容易，这表明如果患者因ITCZ口服溶液的苦味而给药困难，ITCZ凝胶可以使患者更容易继续治疗。此外，已证实即使是ITCZ凝胶，其血浆浓度也适合预防。这也表明使用凝胶制剂可以维持ITCZ的疗效。对于HSCT等真菌感染高危患者的长期抗真菌治疗，保持良好的依从性对于成功预防至关重要。
