Chandrasekar P H, Gatny C M
Infectious Diseases/Hematology-Oncology Liaison Unit, Wayne State University School of Medicine, Detroit, MI 48201.
J Antimicrob Chemother. 1994 Feb;33(2):309-18. doi: 10.1093/jac/33.2.309.
The impact of prophylaxis with 400 mg/day fluconazole on fungal colonization at different body sites was assessed in a randomized, double-blind, placebo controlled study among patients with leukaemia and those undergoing bone marrow transplantation. The study drug was given throughout the period of neutropenia and samples were obtained at weekly intervals. Of the 23 patients in each group, 11 of those given fluconazole and 12 placebo recipients were colonized at entry. The commonest sites were the oropharynx and rectum and Candida albicans was the most frequent isolate. Fluconazole led to a marked reduction in colonization by the second week of treatment to 29% compared with 68% for those given the placebo. Two-weeks after stopping the study regimen there was little change with yeast being isolated from 33% and 81% respectively. Fluconazole was particularly effective in reducing the carriage of C. albicans in the oropharynx from 46% to 0-10% and in maintaining this throughout prophylaxis. Recovery of Candida (Torulopsis) glabrata from the perianal region steadily increased to around 30% in both patient groups and while Candida krusei species were found exclusively in patients given fluconazole, other candida were more common in the placebo group. These results demonstrate that by rapidly reducing the colonization of the alimentary tract, fluconazole eliminates the major reservoir for infection with yeasts other than C. glabrata and C. krusei during the critical period of neutropenia.
在一项针对白血病患者和接受骨髓移植患者的随机、双盲、安慰剂对照研究中，评估了每天400毫克氟康唑预防对不同身体部位真菌定植的影响。在中性粒细胞减少期间全程给予研究药物，并每周采集样本。每组23名患者中，入组时接受氟康唑治疗的患者有11例、接受安慰剂治疗的患者有12例出现真菌定植。最常见的部位是口咽和直肠，白色念珠菌是最常见的分离菌株。与接受安慰剂治疗的患者（68%）相比，氟康唑治疗至第二周时真菌定植显著减少至29%。停止研究方案两周后，变化不大，分别有33%和81%的患者分离出酵母菌。氟康唑在将口咽中白色念珠菌的携带率从46%降至0 - 10%并在整个预防过程中保持这一水平方面特别有效。在两组患者中，肛周区域光滑念珠菌（Torulopsis）的检出率稳步上升至约30%，虽然克鲁斯念珠菌仅在接受氟康唑治疗的患者中发现，但其他念珠菌在安慰剂组中更为常见。这些结果表明，通过迅速减少消化道的真菌定植，氟康唑在中性粒细胞减少的关键时期消除了除光滑念珠菌和克鲁斯念珠菌之外的酵母菌感染的主要储存库。
