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两性霉素B去氧胆酸盐(两性霉素B,商品名:Fungizone)、脂质体两性霉素B(商品名:安必素)和氟康唑在免疫功能正常和白细胞减少小鼠中治疗系统性念珠菌病的疗效。

Efficacies of amphotericin B-desoxycholate (Fungizone), liposomal amphotericin B (AmBisome) and fluconazole in the treatment of systemic candidosis in immunocompetent and leucopenic mice.

作者信息

van Etten E W, van den Heuvel-de Groot C, Bakker-Woudenberg I A

机构信息

Department of Clinical Microbiology and Antimicrobial Therapy, Erasmus University, Rotterdam, The Netherlands.

出版信息

J Antimicrob Chemother. 1993 Nov;32(5):723-39. doi: 10.1093/jac/32.5.723.

Abstract

The in-vitro activities of amphotericin B-desoxycholate (AmB-DOC), liposomal amphotericin B (L-AmB) and fluconazole were determined against a single strain of Candida albicans. In addition, the efficacies of these agents in the treatment of systematic candidosis in both immunocompetent and leucopenic mice were compared. The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) of AmB-DOC and L-AmB were similar, but on the basis of time-kill studies, the fungicidal activity of L-AmB was significantly less than that of AmB-DOC. In immunocompetent mice, the dosage of AmB-DOC was limited by toxicity, resulting in a maximum tolerated dosage (MTD) of 0.4 mg/kg/day during treatment for 5 days; L-AMB was less toxic, the MTD being 7 mg/kg/day following a treatment period of the same duration. Both AmB-DOC and L-AmB led to significant reductions in the numbers of C. albicans in the kidneys of these mice and prevented relapse of infection after completion of treatment. Fluconazole in dosages of 0.4 and 64 mg/kg/day resulted in initial reductions in the numbers of cfu but failed to prevent relapse. In leucopenic mice, treatment for 5 days with AmB-DOC in a dosage of 0.3 mg/kg/day resulted in survival of the animals and a significant reduction in the numbers of cfu in the liver, spleen and lungs. However, there was no reduction in the number of cfu in the kidneys and this led to relapse of infection once therapy was terminated. Fluconazole in a dosage of 64 mg/kg/day produced effects which were similar to those of AmB-DOC; prolonged treatment with fluconazole for 18 days did not improve the efficacy of this agent. Only treatment with high-dosage (7 mg/kg/day) L-AmB was effective in significantly reducing the numbers of cfu of C. albicans in the kidneys and other organs of leucopenic mice, as well as preventing relapse, even in severely infected animals.

摘要

测定了两性霉素B去氧胆酸盐(AmB-DOC)、脂质体两性霉素B(L-AmB)和氟康唑对单一白色念珠菌菌株的体外活性。此外,还比较了这些药物在免疫功能正常和白细胞减少小鼠中治疗系统性念珠菌病的疗效。AmB-DOC和L-AmB的最低抑菌浓度(MIC)和最低杀菌浓度(MFC)相似,但根据时间杀菌研究,L-AmB的杀菌活性明显低于AmB-DOC。在免疫功能正常的小鼠中,AmB-DOC的剂量受毒性限制,在治疗5天期间最大耐受剂量(MTD)为0.4mg/kg/天;L-AMB毒性较小,在相同疗程后的MTD为7mg/kg/天。AmB-DOC和L-AmB均导致这些小鼠肾脏中白色念珠菌数量显著减少,并防止治疗结束后感染复发。剂量为0.4和64mg/kg/天的氟康唑导致cfu数量最初减少,但未能防止复发。在白细胞减少的小鼠中,以0.3mg/kg/天的剂量用AmB-DOC治疗5天可使动物存活,并使肝脏、脾脏和肺部的cfu数量显著减少。然而,肾脏中的cfu数量没有减少,一旦治疗终止,这导致感染复发。剂量为64mg/kg/天的氟康唑产生的效果与AmB-DOC相似;用氟康唑延长治疗18天并未提高该药物的疗效。只有高剂量(7mg/kg/天)的L-AmB治疗才能有效显著减少白细胞减少小鼠肾脏和其他器官中白色念珠菌的cfu数量,并防止复发,即使在严重感染的动物中也是如此。

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