McManus E J, Jones J M
Am Rev Respir Dis. 1986 Jan;133(1):141-3. doi: 10.1164/arrd.1986.133.1.141.
We retrospectively reviewed our experience using ketoconazole in the therapy of blastomycosis. Over the course of 30 months, blastomycosis was diagnosed in 11 patients. Their clinical presentations ranged from the asymptomatic pulmonary nodule to the adult respiratory distress syndrome. Six of 8 patients treated with ketoconazole completed a 6-month course of 400 mg daily. Seventeen to 40 months after completion of therapy, the patients who had completed 6 months of therapy were well. Ketoconazole should play a major role in the therapy of blastomycosis because of its efficacy and because its administrative costs are lower than those of amphotericin B. It can be recommended for patients who have been symptomatic for longer than 3 wk and are not improving and for those who undergo resection of an asymptomatic pulmonary nodule. Amphotericin B remains the drug of choice in patients with life-threatening illness who require ventilatory assistance, have developed renal failure, or have central nervous system involvement. Severely immunocompromised patients with disseminated disease should also be treated with amphotericin B. Patients treated with ketoconazole should have close medical follow-up.
我们回顾性地分析了使用酮康唑治疗芽生菌病的经验。在30个月的时间里，共诊断出11例芽生菌病患者。他们的临床表现从无症状性肺结节到成人呼吸窘迫综合征不等。8例接受酮康唑治疗的患者中有6例完成了为期6个月、每日400毫克的疗程。治疗结束后17至40个月，完成6个月疗程的患者情况良好。酮康唑应在芽生菌病治疗中发挥主要作用，因其疗效显著且管理成本低于两性霉素B。对于症状持续超过3周且病情无改善的患者以及无症状性肺结节接受切除术的患者，可推荐使用酮康唑。对于需要通气支持、已出现肾衰竭或有中枢神经系统受累的危及生命疾病患者，两性霉素B仍是首选药物。严重免疫功能低下的播散性疾病患者也应接受两性霉素B治疗。接受酮康唑治疗的患者应接受密切的医学随访。
