Summary
In this prospective, randomized study fluconazole and amphotericin B/5-flucytosine were compared in the treatment of systemic candidiasis. Seventy-two non-neutropenic intensive care patients with systemicCandida infections were enrolled. Thirty-six patients were randomly assigned to receive fluconazole (400 mg on the first day then 200 mg) and 36 were randomized to amphotericin B/5-flucytosine (1.0–1.5 mg/kg body weight every other day and 3×2.5 g flucytosine/day) for 14 days following the diagnosis. There was no statistically significant difference in clinical outcome in regard to the treatment of pneumonia and sepsis: 18/28 of the patients were treated successfully with fluconazole and 17/27 with amphotericin B/5-flucytosine. For the treatment of peritonitis, however, amphotericin B/5-flucytosine was more effective than fluconazole (55% vs. 25%). Furthermore, amphotericin B/5-flucytosine was found to be superior to fluconazole with regard to pathogen eradication (86% vs. 50%). Fluconazole was associated with less toxicity than amphotericin B/5-flucytosine.
Zusammenfassung
In dieser prospektiven, randomisierten Studie wurde die Wirksamkeit von Fluconazol (400 mg am ersten Tag der Therapie, dann 200 mg) gegenüber der Kombination von Amphotericin B/5-Flucytosin (1–1.5 mg/kg Körpergewicht Amphotericin B jeden zweiten Tag und 3×2.5 g 5-Flucytosin/die) verglichen. Es wurden 72 Patienten (36 in die Fluconazol-Gruppe und 36 in die Amphotericin-Gruppe) aufgenommen und mindestens 14 Tage lang nach der Diagnosestellung behandelt. Bei der Behandlung der Sepsis und Pneumonie ergaben sich in beiden Gruppen keine signifikanten Unterschiede in bezug auf die Heilungsrate (63% in der Fluconazol-Gruppe und 64% in der Amphotericin-Gruppe). Bei der Therapie der Peritonitis war Amphotericin B/5-Flucytosin überlegen (55% vs. 25%). Außerdem war unter der Kombinationstherapie die Keimelimination höher (86% vs. 50%). Während der Therapie mit Fluconazol traten weniger oft Nebenwirkungen auf.
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Abele-Horn, M., Kopp, A., Sternberg, U. et al. A randomized study comparing fluconazole with amphotericin B/5-flucytosine for the treatment of systemicCandida infections in intensive care patients. Infection 24, 426–432 (1996). https://doi.org/10.1007/BF01713042
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DOI: https://doi.org/10.1007/BF01713042