Kibbler C C
Department of Medical Microbiology, Royal Free Hospital, London, U.K.
Curr Top Med Mycol. 1997 Dec;8(1-2):5-14.
Empirical antifungal therapy has become established as standard practice in hematology and oncology units over the past decade and its use is increasing. A number of agents have been evaluated and intravenous amphotericin B has emerged as the drug of choice. Evidence of its benefit is limited and only clearly demonstrated in patients not receiving prior antifungal prophylaxis. However, although there have been improvements in the diagnosis of invasive fungal infections, it has been well shown that many patients who die during periods of neutropenia succumb to undiagnosed fungal infection, and also, if treatment is to be effective, it should be started as soon as possible after the onset of infection. Better targeting of antifungal prophylaxis (or preemptive therapy) and empirical therapy may now be possible and standard empirical therapy needs to be reevaluated in the light of changes in the underlying immune status of neutropenic patients and the development of new antifungal agents for prophylaxis and treatment.
在过去十年中，经验性抗真菌治疗已成为血液科和肿瘤科的标准治疗方法，且其应用正在增加。多种药物已得到评估，静脉注射两性霉素B已成为首选药物。其益处的证据有限，仅在未接受过抗真菌预防治疗的患者中得到明确证实。然而，尽管侵袭性真菌感染的诊断已有改善，但已充分表明，许多在中性粒细胞减少期死亡的患者死于未被诊断出的真菌感染，而且，如果治疗要有效，应在感染发作后尽快开始。现在可能实现更好地靶向抗真菌预防（或先发治疗）和经验性治疗，并且需要根据中性粒细胞减少患者潜在免疫状态的变化以及用于预防和治疗的新型抗真菌药物的开发情况，重新评估标准经验性治疗。
