Graybill J R, Burgess D S, Hardin T C
Department of Medicine, University of Texas Health Science Center at San Antonio 78284, USA.
Eur J Clin Microbiol Infect Dis. 1997 Jan;16(1):42-50. doi: 10.1007/BF01575120.
Are there any fungicidal drugs available today? A critical issue in answering this question is that of definition. The simplest, most stringent definitions identify fungistatic drugs as those that inhibit growth, whereas fungicidal drugs kill fungal pathogens. The immunocompetent host is usually far better equipped to eliminate fungal pathogens than the immunosuppressed host. Therefore, it would be especially desirable to have a truly fungicidal drug, one that absolutely kills and fungi, as a treatment option for the immunosuppressed patient. The critical question would be whether a fungicidal drug can be delivered to the target site in a concentration high enough for a sufficient time to reduce the intralesional fungal counts to zero. By this simple definition, there are no fungicidal drugs available today. However, an accepted alternative definition is that often used by the bacteriologist: Fungicidal drugs are those that lead to a reduction of 99.9% of the initial inocula. Although this less restrictive in vitro standard is more easily met, it has serious limitations. Whether the 99.9% kill should be an acceptable standard remains uncertain. As an alternative, the minimum inhibitory concentration, though indicating static activity, has served well; perhaps it should be the only information reported for fungal susceptibility testing.
如今有抗真菌药物吗？回答这个问题的一个关键问题是定义问题。最简单、最严格的定义将抑菌药物定义为抑制生长的药物，而杀菌药物则杀死真菌病原体。免疫功能正常的宿主通常比免疫抑制宿主更有能力清除真菌病原体。因此，对于免疫抑制患者的治疗选择而言，特别需要一种真正的杀菌药物，即一种能绝对杀死真菌的药物。关键问题在于，一种杀菌药物能否以足够高的浓度在足够长的时间内输送到靶部位，从而将病灶内的真菌数量降至零。按照这个简单的定义，如今没有杀菌药物。然而，细菌学家常用的一种公认的替代定义是：杀菌药物是那些能使初始接种菌量减少99.9%的药物。尽管这个体外标准限制较少，更容易达到，但它有严重的局限性。99.9%的杀灭率是否应作为一个可接受的标准仍不确定。作为一种替代方法，最低抑菌浓度虽然表明的是抑菌活性，但一直很有用；也许它应该是真菌药敏试验报告的唯一信息。
