Department of Clinical Microbiology, Trinity College Dublin, St James's Hospital, Dublin 8, Ireland.
Br J Haematol. 2011 Jun;153(6):681-97. doi: 10.1111/j.1365-2141.2011.08650.x. Epub 2011 Apr 20.
Antifungal prophylaxis during treatment for haematological malignancies has been studied for 50 years, yet it has not been wholly effective even when using antifungal drugs that exhibit potent activity in vitro against a broad range of fungal pathogens. Trials have demonstrated that it can reduce the incidence of invasive fungal diseases (IFD) and fungal deaths, but only two studies have had an impact on overall mortality. Furthermore, it has not significantly reduced the need for empirical antifungal therapy. Posaconazole was effective in preventing invasive aspergillosis in two studies of high-risk patients, and consensus guidelines grade it as a suitable choice for antifungal prophylaxis of invasive mould disease; however, its bioavailability was compromised by vomiting or diarrhoea so that an alternative parenteral antifungal drug was required. A recent trial of voriconazole prophylaxis after allogeneic stem cell transplantation failed to show superiority over fluconazole. With more accurate definitions of IFD, that utilize fungal biomarkers, such as galactomannan, together with computerized tomographic imaging, there is growing interest in a diagnostic-driven strategy, which could prove to be a more efficacious approach.
抗真菌预防治疗血液系统恶性肿瘤已经研究了 50 年，然而，即使使用体外对广泛的真菌病原体具有强大活性的抗真菌药物，也不完全有效。试验表明，它可以降低侵袭性真菌感染（IFD）和真菌感染死亡率，但只有两项研究对总死亡率有影响。此外，它并没有显著减少经验性抗真菌治疗的需要。泊沙康唑在两项高危患者的研究中有效预防侵袭性曲霉菌病，共识指南将其评为侵袭性霉菌病抗真菌预防的合适选择；然而，由于呕吐或腹泻，其生物利用度受到影响，因此需要使用其他的静脉用抗真菌药物。最近一项异基因干细胞移植后伏立康唑预防的试验未能显示优于氟康唑。随着对 IFD 的更准确定义，即利用真菌生物标志物（如半乳甘露聚糖）以及计算机断层扫描成像，人们对诊断驱动的策略越来越感兴趣，这可能被证明是一种更有效的方法。
