Dupont B
Institut Pasteur, Hôpital et Unité de Mycologie, Paris, France.
Pathol Biol (Paris). 1994 Sep;42(7):688-93.
Invasive aspergillosis is an opportunist infection in immunosuppressed hosts among the most difficult to diagnose and to treat. A wide variety of clinical forms exist which may not require the same treatment for each of them. Intravenous amphotericin B and itraconazole are the only available antifungal agents. Amphotericin B is often considered as the gold standard treatment despite its high toxicity particularly with high dosage (1-1.5 mg/kg/day) and its poor results namely in bone marrow transplant recipients. Lipidic amphotericin B is less toxic allowing administration of higher dose however relevant data are limited. Itraconazole is an excellent anti Aspergillus antifungal with low toxicity, however there is a wide intersubject variation in intestinal absorption. It may represent a valuable alternative to amphotericin B in case of intolerance or as a relay treatment and possibly in some cases as a first choice treatment. More studies are necessary particularly in granulopenic patients. Comparative study are urgently needed between both drugs and with new molecules to indicate the best treatment according to the clinical form. The use of hematopoietic growth factors and surgery may improve the outcome.
侵袭性曲霉病是免疫抑制宿主中一种难以诊断和治疗的机会性感染。它有多种临床形式，每种形式可能不需要相同的治疗方法。静脉注射两性霉素B和伊曲康唑是仅有的可用抗真菌药物。尽管两性霉素B毒性高，尤其是高剂量（1 - 1.5毫克/千克/天）时，且疗效不佳，特别是在骨髓移植受者中，但它常被视为金标准治疗药物。脂质体两性霉素B毒性较小，允许使用更高剂量，然而相关数据有限。伊曲康唑是一种优秀的抗曲霉抗真菌药物，毒性低，但个体肠道吸收差异很大。在不耐受的情况下，它可能是两性霉素B的一种有价值的替代药物，或者作为接力治疗药物，在某些情况下也可能作为首选治疗药物。需要进行更多研究，特别是在粒细胞缺乏患者中。迫切需要对这两种药物以及与新分子进行比较研究，以根据临床形式指明最佳治疗方法。使用造血生长因子和手术可能会改善治疗结果。
