Robinson P A, Knirsch A K, Joseph J A
Pfizer Central Research, Groton, Connecticut 06340.
Rev Infect Dis. 1990 Mar-Apr;12 Suppl 3:S349-63. doi: 10.1093/clinids/12.supplement_3.s349.
Fluconazole therapy was evaluated prospectively in patients with serious fungal infections who failed to respond to or could not tolerate conventional antifungal therapy. Patients were enrolled if they had a life-threatening fungal infection and conventional therapy had failed to eradicate the infection, had caused serious toxic reactions, or was contraindicated. Patients were treated with 200 mg/day, a dosage that could be increased to 400 mg/d if the initial response was not satisfactory. AIDS was the underlying risk factor in 65% of 232 patients evaluated in the study and in 85% of 151 patients with cryptococcal infection. Fifty-eight patients had active cryptococcal infection; 74% had a satisfactory clinical response, and 75% of 44 patients became culture-negative. Patients with inactive infection had a relapse rate of 4.5/1,000 patient-weeks. Twenty-three of 30 patients with coccidioidal infection and 10 of 14 patients with candidiasis or another mycosis were clinically improved. Five patients (2%) discontinued fluconazole therapy because of adverse effects possibly attributable to therapy. Fluconazole may be effective in the treatment of serious fungal infections in patients who cannot continue conventional antifungal therapy.
对那些对传统抗真菌治疗无反应或无法耐受的严重真菌感染患者进行了氟康唑治疗的前瞻性评估。如果患者患有危及生命的真菌感染且传统治疗未能根除感染、已引起严重毒性反应或存在禁忌证，则将其纳入研究。患者接受每日200毫克的治疗，若初始反应不令人满意，剂量可增至每日400毫克。在该研究评估的232例患者中，65%的患者潜在危险因素为艾滋病，在151例隐球菌感染患者中这一比例为85%。58例患者有活动性隐球菌感染；74%的患者临床反应良好，44例患者中有75%培养转阴。非活动性感染患者的复发率为每1000患者周4.5例。30例球孢子菌感染患者中有23例、14例念珠菌病或其他霉菌病患者中有10例临床症状改善。5例患者（2%）因可能归因于治疗的不良反应而停用氟康唑治疗。氟康唑可能对无法继续接受传统抗真菌治疗的患者的严重真菌感染有效。
