伏立康唑一级预防急性白血病患者化疗期间并发真菌感染的临床疗效北大核心

目的:探讨初诊急性白血病患者化疗期间应用伏立康唑进行预防侵袭性真菌病(IFD)的临床疗效及安全性。方法:回顾性分析2016年02月至2018年03月期间我院血液科收治的初诊急性白血病行化疗的患者166例,按照是否使用抗真菌药进行预防性治疗分为观察组(应用伏立康唑进行预防治疗,n=103)和对照组(未应用抗真菌药物,n=63),比较两组患者IFD发生率差异,并分析抗真菌药物应用的不良反应。结果:观察组IFD发生率为10.7%,对照组为33.3%,两组患者的IFD发生率有明显差异(P<0.05);所有应用伏立康唑进行预防治疗的患者均未出现严重的不良反应。结论:伏立康唑可以有效减低急性白血病患者化疗期间IFD发生率,并且有着较好的安全性,值得在临床推广应用。     

Comparison of the EUCAST-AFST broth dilution method with the CLSI reference broth dilution method (M38-A) for susceptibility testing of posaconazole and voriconazole against Aspergillus spp.

The susceptibilities of 40 clinical isolates of Aspergillus spp. (Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, Aspergillus terreus) were determined for posaconazole and voriconazole by the CLSI M38-A and EUCAST-AFST broth dilution methods. Where a discrepancy was observed between the methods, the EUCAST method tended to give higher MIC values. Overall, the level of agreement was 92.5% and the intra-class correlation coefficient was > 0.90.     

注射用伏立康唑无菌检查法的建立

目的：确定新药伏立康唑注射用无菌粉末的无菌检查法。方法：无菌检查法的验证试验——抑细菌和抑真菌试验及冲洗量试验。通过菌悬液的制备、培养基的检查、冲洗量的选择、阳性对照菌的选择及加入顺序等全过程，说明无菌检查法的建立，必须有验证试验的保证。结果：该药的无菌检查选用薄膜过滤法，以黑曲霉为阳性对照菌，冲洗总量1500ml。结论：通过验证试验保证的无菌检查条件检查该药，方法可行，结果可靠。应在药品检验工作中，逐步完善微生物检验方法学的内容，从而提高我国药品微生物检验工作的总体水平。     

新型抗真菌药伏立康唑

伏立康唑 (voriconazole)是第 2代三唑类抗真菌药 ,具有抗菌谱广、抗菌效力强的特点 ,尤其对于侵袭性曲霉菌侵润所致感染疗效好。本品口服吸收好 ,病人也有很好的耐受性。本文对其药效学、药动学、药物相互作用、临床应用、不良反应等研究作一综述。     

高效液相色谱法测定人血浆中伏立康唑浓度

目的：建立一种简单高效的高效液相色谱（HPLC）法用来检测人体中伏立康唑的血药浓度，并应用于临床中伏立康唑用药监测，以促进其个体化用药。方法：色谱柱：Kromasil C₁₈（4.6 mm×150 mm，5 μm），柱温：35℃，流速：1.0 mL·min^-1，流动相：甲醇-水（60：40），检测波长：257 nm，内标：酮康唑。对该方法进行方法学验证。结果：该方法专属性良好，血浆中伏立康唑在0.1~20.0 μg·mL^-1范围内线性良好（r=0.999 6），定量下限为0.1 μg·mL^-1。高、中、低3个浓度提取回收率分别为（90.68±10.32）%、（92.82±8.26）%、（97.47±4.58）%；日内精密度RSD分别为5.87%、7.85%、4.10%；日间精密度RSD分别为5.64%、3.30%、2.74%。对某院20例（男12例，女8例）使用伏立康唑抗真菌治疗的患者运用该方法进行了监测，结果显示浓度范围在0.71~13.51 μg·mL^-1之间。结论：本方法专属性高，操作简便，结果准确，可用于临床上伏立康唑血药浓度的检测，从而促进其个体化用药的推广。     

Optimization of voriconazole dosage regimen to improve the efficacy in patients with invasive fungal disease by pharmacokinetic/pharmacodynamic analysis

Invasive fungal disease (IFD) is a significant cause of morbidity and mortality in hospitalized patients. To maximize the efficacy of voriconazole treatment, the study established the relationship between voriconazole pharmacokinetic/pharmacodynamic (PK/PD) and probability of response and optimized voriconazole dosage regimen in patients with IFD based on Monte Carlo simulation. Forty‐four patients proven with IFD were involved in this study. Among them, the overall cure rate was 75% (33/44) and there was a significant difference between C_min/MIC values in patients with lack of response (n = 11) and those with successful response (n = 33) (mean value: 1.91 vs. 11.33; P < 0.05). Logistic regression model showed a high correlation between voriconazole C_min/MIC ratio and clinical response (P = 0.044, OR = 1.349). According to Monte Carlo simulation results under different voriconazole dosing regimens, we could draw a conclusion that 200 mg voriconazole administered intravenously or orally twice daily for Candida infections and 300 mg administered orally or with 200 mg administered intravenously twice daily for Aspergillus infections were rational, which could achieve a value of the cumulative fraction of response >90%. This study built the relationship between voriconazole PK/PD and clinical response and obtained the reasonable empirical dosage regimen, which can be used to customize individual dosage regimen and improve the efficacy of voriconazole treatment.     

Comparison of micafungin and voriconazole in the treatment of invasive fungal infections in kidney transplant recipients

What is known and Objective: Invasive fungal infections are a major threat to renal transplant recipients. Micafungin and voriconazole are two useful antifungal agents for treating such infections. Our objective is to evaluate the comparative efficacy and safety of micafungin and voriconazole in the initial treatment of such infections. Methods: In this prospective, multicentre, open‐labelled, randomized, controlled trial, renal transplant recipients with invasive fungal infections were assigned to receive either micafungin or voriconazole. The enrolled subjects received a kidney transplant between March 2008 and March 2010 at one of the two transplant centres in Henan Province, China. The efficacy and adverse effects of the two treatments were compared. Results and Discussion: The clinical trial enrolled 65 patients, of whom 31 were treated with micafungin, and 34 with voriconazole. The rates of microbiological evidence of infection in the micafungin and voriconazole groups were 64·5% and 70·5%, respectively, whereas the rates of Candida as the major cultured fungus were 80·0% and 75·0%, respectively. Complicated bacterial infection rates in the two treatment groups were 38·7% and 32·4%, respectively, whereas complicated CMV viral infection occurred at a rate of 19·2% and 23·5%, respectively. Fungal infection within one to 3 months after transplant was 83·6% (26/31) and 85·3% (29/34) in the micafungin and voriconazole groups, respectively. There was no significant difference between the two groups in terms of efficacy, survival beyond 10 days and discontinuation of treatment because of lack of efficacy (P > 0·05). Mortality rates in the micafungin and voriconazole groups were 9·7% (3/31) and 12·1% (4/33), respectively. Rates of adverse effects in the two groups were 41·9% and 51·6% (P > 0·05), respectively. What is new and Conclusions: This is the first comparison of micafungin and voriconazole in renal transplant patients. Our study shows that the effectiveness of micafungin was similar to that of voriconazole in such patients.