Jones H E
Emory University, Atlanta, Ga.
J Am Acad Dermatol. 1990 Oct;23(4 Pt 2):779-81. doi: 10.1016/0190-9622(90)70287-r.
Recalcitrant fungal infections are defined as infections that are difficult or impossible to eradicate despite seemingly adequate treatment with appropriate oral or parenteral antibiotics. Relative or absolute microbial resistance is only one of the many causes of recalcitrance. Others include failure of the patient to comply with the prescribed treatment regimen, drug degradation in the liver, drug-drug interactions, reabsorption or washout of the drug from the stratum corneum, and failure of the drug to reach the stratum corneum. Excretion in the eccrine sweat is the principal pathway by which griseofulvin and ketoconazole, the two currently available oral antifungal agents, are delivered to the stratum corneum. Measures that promote delivery of these drugs to this site by enhancing sweating and minimizing drug run-off and absorption onto clothing may aid in optimizing the therapeutic response to these agents.
顽固性真菌感染被定义为尽管使用了适当的口服或注射用抗生素进行了看似充分的治疗，但仍难以或无法根除的感染。相对或绝对的微生物耐药性只是导致顽固性的众多原因之一。其他原因包括患者未遵守规定的治疗方案、药物在肝脏中的降解、药物相互作用、药物从角质层的再吸收或冲洗以及药物无法到达角质层。外分泌汗腺分泌是目前两种可用的口服抗真菌药物灰黄霉素和酮康唑输送到角质层的主要途径。通过增强出汗并尽量减少药物流失和衣物吸收来促进这些药物向该部位输送的措施，可能有助于优化对这些药物的治疗反应。
