抗真菌药临床应用进展.pptVIP

Indications serious infections caused by susceptible strains of candida and/or cryptococcus Candida septicemia, endocaarditis, urinary tract infections and pulmanary infections Cryptococcus meningitis, pulmanary infections, septicemia, urinary tract infections Flucytosine The Azoles Triazoles Fluconazole Itraconazole Voriconazole Posaconazole Ravuconazole Fluconazole Azole – IV, oral suspension, capsule Spectrum Useful against cryptococcus and C.albicans Ineffective against some Candida species such as C.krusei and C.glabrata Ineffective against Aspergillus species Fluconazole Indications Cryptococcal meningitis Systemic infections caused by Candida sp. Vaginal candidiasis - single 150 mg dose. Oralpharyngeal/esophageal candidiasis Prophylaxis - BMT and chemotherapy patients to decrease the incidence of candidiasis. Itraconazole Azole – IV, oral solution, capsules Very broad spectrum – covers aspergillus, candida, cryptococcus, blastomyces, histoplasma and others Itraconazole Pharmacokinetics – not ideal Oral absorption not good－33％ and 55% Liquid tastes bad Very highly protein bound Needs repeated dosing before optimal concentrations are achieved Poor CSF concentrations, reasonable tissue concentrations Itraconazole Indications for capsules Blastomycoses - pulmonary and extrapulmonary Histoplasmosis- pulmonary and disseminated Aspergillosis - pulmonary and extrapulmonary Onychomycosis due to dermatophytes of the toenails and fingernails. Itraconazole Indications for oral solution Febrile neutropenic patients with suspected fungal infections Oralpharyngeal/esophageal candidiasis Indications for intravenous Febrile neutropenic patients with suspected fungal infections Blastomycoses - pulmonary and extrapulmonary Histoplasmosis- pulmonary and disseminated Aspergillosis - pulmonary and extrapulmonary Triazole Antifungals: Voriconazole, Posaconazole, Ravuconazole Spectrum of Activity Candida spp. Aspergillus spp. Blastomyces spp. Histoplasma spp. Cryptoco