新生儿侵袭性念珠菌病氟康唑治疗与预防的综述
Review of Fluconazole Treatment and Prophylaxis for Invasive Candidiasis in Neonates.
作者信息
Hornik Chi D, Bondi Deborah S, Greene Nicole M, Cober M Petrea, John Barnabas
出版信息
J Pediatr Pharmacol Ther. 2021;26(2):115-122. doi: 10.5863/1551-6776-26.2.115. Epub 2021 Feb 15.
Abstract
Invasive candidiasis accounts for approximately 10% of nosocomial infections in preterm infants, with an incidence of 1% to 4% among neonatal intensive care unit (NICU) admissions and a mortality as high as 20% to 30%. These outcomes warrant improved treatment and prevention strategies for infants at highest risk. The Infectious Diseases Society of America provides guidelines on antifungal medications for the prophylaxis and treatment of candidiasis in NICUs; however, there are still variations in practice on the use of fluconazole for prophylaxis and treatment of invasive candidiasis. This review provides specific information regarding fluconazole activity, pharmacokinetics, and a literature evaluation of dosing strategies and comparisons to other treatments in the neonatal population.
摘要
侵袭性念珠菌病约占早产儿医院感染的10%，在新生儿重症监护病房（NICU）收治的患儿中发病率为1%至4%，死亡率高达20%至30%。这些结果表明，需要改进针对高危婴儿的治疗和预防策略。美国传染病学会提供了关于在NICU中预防和治疗念珠菌病的抗真菌药物指南；然而，在使用氟康唑预防和治疗侵袭性念珠菌病方面，实际操作仍存在差异。本综述提供了有关氟康唑活性、药代动力学的具体信息，以及对新生儿人群给药策略的文献评估和与其他治疗方法的比较。
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本文引用的文献
1
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J Antimicrob Chemother. 2018 Dec 1;73(12):3482-3487. doi: 10.1093/jac/dky353.
2
Pharmacokinetics and safety of fluconazole and micafungin in neonates with systemic candidiasis: a randomized, open-label clinical trial.氟康唑和米卡芬净在患有全身性念珠菌病的新生儿中的药代动力学和安全性：一项随机、开放标签的临床试验。
Br J Clin Pharmacol. 2018 Sep;84(9):1989-1999. doi: 10.1111/bcp.13628. Epub 2018 Jun 21.
3
A Phase 3 Study of Micafungin Versus Amphotericin B Deoxycholate in Infants With Invasive Candidiasis.一项比较米卡芬净与两性霉素 B 去氧胆酸盐治疗侵袭性念珠菌病婴儿的 3 期研究。
Pediatr Infect Dis J. 2018 Oct;37(10):992-998. doi: 10.1097/INF.0000000000001996.
4
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J Pediatr. 2017 Jun;185:129-135.e6. doi: 10.1016/j.jpeds.2017.02.039. Epub 2017 Mar 10.
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Antimicrob Agents Chemother. 2016 Aug 22;60(9):5539-45. doi: 10.1128/AAC.00963-16. Print 2016 Sep.
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BMC Pediatr. 2016 May 16;16:67. doi: 10.1186/s12887-016-0605-y.
8
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9
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