Odds F C
Department of Bacteriology and Mycology, Janssen Research Foundation, Beerse, Belgium.
J Antimicrob Chemother. 1993 Apr;31(4):463-71. doi: 10.1093/jac/31.4.463.
There are relatively few antifungal agents available for the treatment of systemic mycoses. The incidence of these infections, particularly among the immunocompromised, has increased significantly in recent years. Amphotericin B, flucytosine and the azole-derivatives--fluconazole, itraconazole and ketoconazole--are the only drugs of value in the treatment of systemic yeast infections currently available. To date resistance among individual yeast species or strains has only been a serious problem with flucytosine. However, resistance among Candida spp. to orally administered azole-derivatives has been observed. The frequency with which resistance has been described in clinical practice among yeasts differs considerably between the three azole antifungal agents. Fluconazole has been implicated in emergent resistance more frequently than ketoconazole, and ketoconazole more often than itraconazole. It must be a matter for concern that, by analogy with the known emergence of antibiotic-resistance among bacteria, that the widespread use of a drug inactive against a particular species may lead to an increased incidence of such infections. An international epidemiological survey is required to establish the extent and degree of resistance to the azole antifungals.
可用于治疗全身性真菌病的抗真菌药物相对较少。近年来，这些感染的发病率显著上升，尤其是在免疫功能低下者中。两性霉素B、氟胞嘧啶和唑类衍生物——氟康唑、伊曲康唑和酮康唑——是目前治疗全身性酵母菌感染唯一有价值的药物。迄今为止，单个酵母菌种类或菌株的耐药性仅在氟胞嘧啶方面成为一个严重问题。然而，已观察到念珠菌属对口服唑类衍生物产生耐药性。在临床实践中，三种唑类抗真菌药物之间，酵母菌耐药性的描述频率差异很大。与酮康唑相比，氟康唑与新出现的耐药性关联更频繁，而酮康唑比伊曲康唑更常出现耐药性。必须引起关注的是，类似于已知细菌中抗生素耐药性的出现，对特定菌种无活性的药物广泛使用可能会导致此类感染的发病率增加。需要进行一项国际流行病学调查，以确定对唑类抗真菌药物的耐药程度和范围。
