Salavert-Lletí Miguel, Zaragoza-Crespo Rafael
Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Valencia, España.
Rev Iberoam Micol. 2009 Mar 31;26(1):81-9. doi: 10.1016/S1130-1406(09)70015-4. Epub 2009 May 7.
Micafungin is a echinocandin. It inhibits beta-1,3-D-glucan synthesis, thus achieving fungicidal activity against virtually all Candida spp., including those resistant to fluconazole, and fungistatic activity against Aspergillus spp., as well as several but not all pathogenic molds. Results from in vitro studies, animal models, small clinical trials, hint at possible future indications such as invasive aspergillosis and empirical viantifungal therapy, although currently there is little information published.
To describe published data of micafungin as treatment against invasive mold infections, specially analysing its role in the inmunodepressed host and critical care setting.
A systematic review of literature using the principal medical search engines was performed. Terms such as micafungin, aspergillosis, zygomycosis, invasive fungal infections, emerging fungal infections, antifungal treatment or therapy, antifungal prophylaxis, empiric or pre-emptive therapy were crossed. Febrile neutropenia patients were excluded.
Several studies in these setting were identified and were described in this review. Although there were no blinded randomized clinical trials published, treatment or prophylaxis of invasive aspergillosis and other invasive mould infections with micafungin described in open clinical studies were analyzed.
Micafungin could play a future important role as a primary or rescue therapy, alone or in combination, in the treatment or prophylaxis of invasive fungal infections caused by moulds. New randomized clinical trials are needed to confirm their efficacy.
米卡芬净是一种棘白菌素。它抑制β-1,3-D-葡聚糖的合成，从而对几乎所有念珠菌属具有杀菌活性，包括对氟康唑耐药的念珠菌，对曲霉属具有抑菌活性，以及对几种但并非所有致病性霉菌也有抑菌活性。体外研究、动物模型和小型临床试验的结果提示了其未来可能的适应证，如侵袭性曲霉病和经验性抗真菌治疗，尽管目前发表的相关信息较少。
描述已发表的关于米卡芬净治疗侵袭性霉菌感染的数据，特别分析其在免疫抑制宿主和重症监护环境中的作用。
使用主要医学搜索引擎对文献进行系统综述。交叉检索米卡芬净、曲霉病、接合菌病、侵袭性真菌感染、新出现的真菌感染、抗真菌治疗或疗法、抗真菌预防、经验性或先发制性治疗等术语。排除发热性中性粒细胞减少患者。
在这些环境中确定了几项研究，并在本综述中进行了描述。尽管没有发表盲法随机临床试验，但分析了开放临床研究中描述的用米卡芬净治疗或预防侵袭性曲霉病和其他侵袭性霉菌感染的情况。
米卡芬净在单独或联合作为主要或挽救治疗用于治疗或预防由霉菌引起的侵袭性真菌感染方面，未来可能发挥重要作用。需要新的随机临床试验来证实其疗效。
