Abdel-Rahman Susan M, Wright Krista J, Navarre Harriett C
Division of Pediatric Clinical Pharmacology and Medical Toxicology, The Children's Mercy Hospital ; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
J Pediatr Pharmacol Ther. 2009 Apr;14(2):94-9. doi: 10.5863/1551-6776-14.2.94.
Using genetic strain typing, we previously identified a high rate of T. tonsurans carriage among preschool-aged children attending an urban daycare center. No treatment was provided as part of the observational study; however, children when symptomatic were treated in accordance with daycare policies. This retrospective investigation examines antifungal drug therapy received during the previous investigation and characterizes the impact of treatment on persistence of the fungus on the scalp.
Children in whom serial typeable isolates of T. tonsurans were recovered were eligible for evaluation. Clinic charts were reviewed and dispensing records obtained from the primary pharmacies serving the daycare. Infection patterns were examined before and after treatment.
We identified 72 dispensing records for 53 children, all of whom received griseofulvin. Nine children could not be evaluated because treatment was coincident with their last study visit. Thus, 63 treatment events in 44 children with 331 discrete infection events remained. After a single course of griseofulvin, 22.7% of children became culture negative, 6.8% acquired another strain of T. tonsurans and, 70.5% remained persistently positive with the same strain carried prior to treatment. Among those receiving a second course of therapy, 54% remained positive and the cumulative percent of children that became culture negative increased to 36.4%. If children subsequently acquiring a different strain are considered together with those that became culture negative, cumulative strain clearance was observed in 43% of children. Neither the griseofulvin dose nor the duration of time over which children were infected prior to treatment differed between those that remained positive and those that became negative.
Griseofulvin eradicates dermatophyte scalp carriage in less than one-half of preschool-aged children receiving between one and four 4-week courses of the drug.
我们之前通过基因菌株分型，在一家城市日托中心的学龄前儿童中发现了较高的断发毛癣菌携带率。作为观察性研究的一部分，未进行任何治疗；然而，有症状的儿童按照日托中心的政策接受了治疗。这项回顾性调查研究了上次调查期间接受的抗真菌药物治疗，并描述了治疗对头皮真菌持续存在的影响。
分离出可连续分型的断发毛癣菌菌株的儿童有资格参与评估。查阅临床病历，并从为日托中心服务的主要药房获取配药记录。检查治疗前后的感染模式。
我们确定了53名儿童的72份配药记录，所有儿童均接受了灰黄霉素治疗。9名儿童无法进行评估，因为治疗与他们最后一次研究访视同时进行。因此，44名儿童的63次治疗事件以及331次离散感染事件得以保留。在接受一个疗程的灰黄霉素治疗后，22.7%的儿童培养结果转为阴性，6.8%感染了另一种断发毛癣菌菌株，70.5%的儿童仍持续呈阳性，携带的是治疗前相同的菌株。在接受第二个疗程治疗的儿童中，54%仍为阳性，培养结果转为阴性的儿童累计百分比增至36.4%。如果将随后感染不同菌株的儿童与培养结果转为阴性的儿童合并计算，43%的儿童实现了累计菌株清除。治疗后仍为阳性的儿童与转为阴性的儿童在灰黄霉素剂量或治疗前感染的时长方面并无差异。
对于接受一至四个为期4周疗程灰黄霉素治疗的学龄前儿童，灰黄霉素根除头皮皮肤癣菌携带的比例不到一半。
