Gadea Ignacio, Mensa José
Departamento de Microbiología, Fundación Jiménez Díaz-UTE, Madrid, España.
Enferm Infecc Microbiol Clin. 2008 Dec;26 Suppl 14:51-5. doi: 10.1016/s0213-005x(08)76593-5.
Combined, simultaneous or sequential antifungal therapy has often been considered an appropriate option to improve the results obtained with monotherapy. Anidulafungin belongs to the echinocandin family, which has a different mechanism of action from the remaining antifungal agents, a characteristic that heralds a good chance of synergy with other groups. However, most of the data available on the efficacy of different combinations comes from animal models of infection, "in vitro" data and case reports, while data from controlled clinical trials are scarce. The available data are insufficient to allow us to conclude that the efficacy of combined therapy is significantly superior to that of monotherapy. However, the efficacy of combined therapy may be adequate for the treatment of severe invasive mycoses associated with high mortality rates, such as forms of aspergillosis that provoke central nervous system involvement, extensive pulmonary involvement, cavitated areas, or respiratory failure and infections caused by multiresistant fungi.
联合、同时或序贯抗真菌治疗通常被认为是提高单药治疗效果的合适选择。阿尼芬净属于棘白菌素类,其作用机制与其他抗真菌药物不同,这一特性预示着与其他药物联合使用有很大的协同增效机会。然而,关于不同联合用药疗效的大多数现有数据来自感染动物模型、“体外”数据和病例报告,而来自对照临床试验的数据却很少。现有数据不足以让我们得出联合治疗疗效明显优于单药治疗的结论。然而,联合治疗的疗效可能足以治疗与高死亡率相关的严重侵袭性真菌病,如引起中枢神经系统受累、广泛肺部受累、空洞形成区域或呼吸衰竭的曲霉病形式,以及由多重耐药真菌引起的感染。