Bennett J E, Dismukes W E, Duma R J, Medoff G, Sande M A, Gallis H, Leonard J, Fields B T, Bradshaw M, Haywood H, McGee Z A, Cate T R, Cobbs C G, Warner J F, Alling D W
N Engl J Med. 1979 Jul 19;301(3):126-31. doi: 10.1056/NEJM197907193010303.
We compared amphotericin B therapy for cryptococcal meningitis with a newer regimen containing both amphotericin B and flucytosine. In 50 patients with 51 courses of therapy adherent to the protocol, 27 courses were with amphotericin B and 24 with the combination. Even though the combination regimen was given for only six weeks and amphotericin B for 10 weeks, the combination cured or improved more patients (16 vs 11), produced fewer failures or relapses (three vs. 11), more rapid sterilization of the cerebrospinal fluid (P less than 0.001) and less nephrotoxicity (P less than 0.05) than did amphotericin B alone. The number of deaths was the same (five) with each regimen. Adverse reactions to flucytosine occurred in 11 of 34 patients but were not life threatening. We conclude that combined flucytosine-amphoericin B therapy is the regimen of choice in cryptococcal meningitis.
我们将两性霉素B治疗隐球菌性脑膜炎与一种包含两性霉素B和氟胞嘧啶的新方案进行了比较。在50例接受51个疗程符合方案治疗的患者中，27个疗程采用两性霉素B治疗，24个疗程采用联合治疗。尽管联合方案仅给药六周，两性霉素B给药十周，但联合治疗治愈或改善的患者更多（16例对11例），失败或复发的患者更少（3例对11例），脑脊液灭菌更快（P<0.001），肾毒性比单独使用两性霉素B更小（P<0.05）。每种方案的死亡人数相同（5例）。34例患者中有11例出现了对氟胞嘧啶的不良反应，但均未危及生命。我们得出结论，氟胞嘧啶-两性霉素B联合治疗是隐球菌性脑膜炎的首选方案。
