Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH, Zurich, Switzerland.
Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland; Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland.
J Glob Antimicrob Resist. 2022 Jun;29:520-526. doi: 10.1016/j.jgar.2021.11.010. Epub 2021 Dec 8.
In this study, we examined the toxicities, including poisoning and overdoses, with polyene, azole, flucytosine and echinocandin antifungals reported to the Swiss National Poison Centre.
An observational cross-sectional study on antifungals was performed based on reports between 1995 and 2016 to Tox Info Suisse. Patient demographic and clinical characteristics were summarised among all reported calls, stratified by age group. In secondary analyses, we evaluated cases with clinical follow-up information.
In total, 149 cases were reported to the National Poison Centre during the study period, of which 49 (32.9%) were male and 91 (61.1%) were female, and 95 (63.8%) were adults and 54 (36.2%) were children (age ≤16 years). The most frequently reported drug class was azoles (136; 91.3%). In 31 cases (20.8%) reported by treating physicians, further clinical follow-up information was available. Nearly one-half of these patients were asymptomatic (15/31; 48.4%). In 11 patients (35.5%) among those with symptoms, the symptoms of toxicity were categorised with a strong causality to the respective antifungal. Clinical findings caused by triazoles were effects in the gastrointestinal tract, hallucinations and predelirium state. Clinical findings caused by polyenes were mostly minor symptoms with infusion-related effects or hypokalaemia. The severity was categorised as minor in 6 (54.5%) of 11 cases and as moderate in 5 cases (45.5%).
Despite high administered doses, no severe or fatal cases occurred within the study period. Although various toxicities can occur with antifungal administration and overdoses, they showed a favourable safety profile.
本研究旨在考察瑞士国家毒理中心报告的多烯、唑类、氟胞嘧啶和棘白菌素类抗真菌药的毒性，包括中毒和用药过量。
对 1995 年至 2016 年期间向 Tox Info Suisse 报告的抗真菌药物进行了基于报告的观察性横断面研究。总结了所有报告电话中患者的人口统计学和临床特征，并按年龄组进行了分层。在二次分析中，我们评估了具有临床随访信息的病例。
在研究期间，国家毒理中心共报告了 149 例病例，其中男性 49 例（32.9%），女性 91 例（61.1%），成人 95 例（63.8%），儿童 54 例（36.2%）（≤16 岁）。报告频率最高的药物类别是唑类（136 例；91.3%）。在由治疗医生报告的 31 例病例中，进一步获得了临床随访信息。这些患者中有近一半（15/31；48.4%）无症状。在有症状的 11 例患者中（35.5%），毒性症状与相应抗真菌药之间存在强因果关系。三唑类引起的临床症状为胃肠道效应、幻觉和谵妄状态。多烯类引起的临床症状大多为轻微症状，伴有输注相关效应或低钾血症。11 例中的 6 例（54.5%）被归类为轻度，5 例（45.5%）为中度。
尽管给予了高剂量，但在研究期间未发生严重或致命病例。尽管抗真菌药物治疗和用药过量可能会出现各种毒性，但它们具有良好的安全性。
