摘要
目的介绍临床如何合理使用两性霉素B脂质体(L-Am B)。方法综述国内外文献,分析其药理特点、适应症和临床合理应用原则。结果两性霉素B(AMB)仍是治疗侵袭性真菌感染的主要药物,但众多的不良反应也限制了其在临床的广泛应用。L-Am B在保留AMB相似的抗真菌疗效的同时,减少了毒副作用。L-Am B具有抗真菌谱广、疗效稳定以及不易诱导真菌耐药等优点,可用于念珠菌病、曲霉、隐球菌病、马尔尼菲青霉病、组织胞浆菌病以及毛霉病等真菌病的治疗,尤其适于重症患者、孕妇以及因基础疾病而不适合使用或不能耐受AMB的患者以及对三唑类药物耐药的真菌感染和存在较多药物间相互作用的情况下,也可作为经验性抗真菌治疗的药物选择及高危人群侵袭性真菌感染的预防性用药。L-Am B价格较高,限制了其在临床的推广和使用。结论临床上应根据真菌感染的类型、感染部位、感染人群、基础疾病、肝肾功能状态、合并用药情况、不良反应、药物的可及性和可接受性等情况来合理使用L-Am B。有必要对L-Am B的临床应用价值和成本—效益进行进一步的研究。
Objective To introduce the clinical rational use of amphotericin B liposome （L-AmB）. Methods Literature review was done to summarize the pharmacological characteristics, indications and rational application principles of L-AmB. Results Amphotericin B （AMB） remains the main therapeutic choice for invasive fungal infections. However, a wide variety of adverse effects also limits its wide use in clinical applications. L-AmB, a lipid containing formulations of AMB, has the similar efficacy and characteristics compared to AMB. L-AmB enhanced drug targeting specific cell targeting and combined transport, relatively reduce the side effects and improve the tolerance of patients. L-AmB is a broad-spectrum antifungal with the stable antifungal effect and low-risk for induction of fungal resistance. It has been widely used for invasive fungal infections. It is mainly used to treat candidiasis, aspergillosis, cryptococcosis, penicilliosis marneffei, histoplasmosis, and mucormycosis. L-AmB is more suitable for critically ill patients, pregnant women and patients who can not tolerate AMB, it is aslo used to treat fungal infection with azole resisitance and patients with drug interactions. L-AmB can also be used as empirical antifungal therapy for suspected invasive fungal infections and as antifungal prophylaxis for high-risk patients. The high price of L-AmB has limited its popularization and use. Conclusion Clinicians should rationally use L-AmB according to the fungal infection type and site, infected population, underlying diseases, liver and renal function, combined medications, side effects, accessibility and acceptability of the antifungals. It is necessary to further study the clinical effectiveness and cost-effectiveness of L-AmB in clinical practice.
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2015年第7期495-499,共5页
Chinese Journal of Antibiotics
基金
上海市"科技创新行动计划"医学引导类项目"艾滋病合并隐球菌脑膜炎抗真菌治疗方案研究"(No.14411970600)
