Dietze R, Fagundes S M, Brito E F, Milan E P, Feitosa T F, Suassuna F A, Fonschiffrey G, Ksionski G, Dember J
Unit of Infectious Diseases, Federal University of Espirito Santo, Vitoria, Brazil.
Trans R Soc Trop Med Hyg. 1995 May-Jun;89(3):309-11. doi: 10.1016/0035-9203(95)90557-x.
We have treated 10 patients suffering from kala-azar in Brazil with Amphocil (amphotericin B cholesterol dispersion) at a dose of 2 mg/kg/d for 5 d, following an earlier study in which this dosage for 7 d was found to cure all of 9 patients, with no relapse during 12 months. In the present study, all patients demonstrated initial resolution of disease. Parasites were absent upon bone marrow re-aspiration 2 weeks after therapy; no spleen extended beyond the costal margin 2 months after therapy; white blood cell counts, platelet counts, and serum levels of albumin rapidly returned to normal. Although one patient relapsed at 5 months, 8 of the other 9 patients had spleens of normal size (undetectable on deep palpation) at 12 months after therapy. Fever, sometimes accompanied by increased respiratory rate, occurred on the first day of drug infusion in 8 of 10 patients and was more severe in patients < 6 years old. Pre-medication with a non-steroidal anti-inflammatory agent (diclofenac potassium) before the next 4 infusions protected against this side effect in 5 of 6 patients. The results of this and our previous study suggest that the most appropriate regimen of Amphocil for kala-azar is 2 mg/kg/d for 7 d, with pre-medication each day, in patients aged > 5 years.
我们在巴西用两性霉素B胆固醇分散体（安浮西）以2毫克/千克/天的剂量治疗了10例黑热病患者，疗程为5天，此前的一项研究发现，该剂量治疗7天可治愈所有9例患者，且在12个月内无复发。在本研究中，所有患者的病情最初均得到缓解。治疗2周后骨髓再次穿刺未发现寄生虫；治疗2个月后脾脏未超过肋缘；白细胞计数、血小板计数和血清白蛋白水平迅速恢复正常。虽然有1例患者在5个月时复发，但其他9例患者中有8例在治疗12个月时脾脏大小正常（深部触诊无法触及）。10例患者中有8例在药物输注第一天出现发热，有时伴有呼吸频率增加，且<6岁的患者症状更严重。在接下来的4次输注前用非甾体抗炎药（双氯芬酸钾）进行预处理，6例患者中有5例预防了这种副作用。本研究及我们之前研究的结果表明，对于年龄>5岁的黑热病患者，安浮西最适宜的治疗方案是2毫克/千克/天，疗程7天，且每天进行预处理。
