两性霉素B联合阿奇霉素及其他抗真菌药对烟曲霉体外抗菌活性研究 FREE

In vitro antifungal activities of amphotericin B combined with azithromycin and other antifungal agents against Aspergillus fumigatus FREE

摘要:

目的探讨两性霉素B（AMB）联合阿奇霉素（AZI）及其他常用抗真菌药对临床分离的30株烟曲霉体外抗菌活性，以指导临床治疗侵袭性曲霉病合理用药。方法药敏试验采用美国临床实验室标准化研究所（CLSI）制定的M38A方案。结果抗真菌药体外抗菌活性依次为伏立康唑（VRC）0.29 μg/mL，卡泊芬净(CBF)0.45 μg/mL，伊曲康唑（ICZ）0.52 μg/mL，AMB 0.55 μg/mL。烟曲霉对特比萘芬（TBF）、5氟胞嘧啶（5FC）、氟康唑（FCZ）、AZI均显示耐药。联合用药有协同作用的为：AMB＋ICZ（96.67%）、AMB+VRC（90.00%）、AMB+CBF（83.33%）、AMB+5FC(50.00%)。结论单独用药时，AMB、ICZ、VRC、CBF有很强的抗烟曲霉作用，烟曲霉对FCZ耐药，AZI无对抗烟曲霉作用；联合用药时，AMB与ICZ、VRC、CBF、5FC有协同抗菌作用。对于侵袭性曲霉病，可选择AMB联合用药。

Abstract:

To evaluate the antifungal activities of amphotericin B (AMB) combination with  azithromycin (AZI) and other antifungal agents  against 30 strains of Aspergillums fumigatus in vitro, so as to guide rational use of antifungals against invasive aspergillosis. MethodsThe M38A method recommended by Clinical and Laboratory Standards Institute was used to detect  antifungal activity of the combination application of antifungal drugs. ResultsThe minimum inhibitory concentration(MIC) of voriconazole(VRC), caspofungin(CBF), itraconazole(ICZ) and AMB against Asperillus fumigatus was 0.29 μg/mL,  0.45 μg/mL, 0.52 μg/mL and 0.55 μg/mL, respectively. Asperillus fumigatus were all resistant to terbinafine, fluorocytosin 5 (5FC),  fluconazole(FCZ) and AZI. The total percentages of synergistic activity for AMB+ICZ, AMB+VRC, AMB+CBF, and AMB+5FC was 96.67%, 90.00%, 83.33% and 50.00% respectively. ConclusionAspergillus fumigatus were highly sensitive to AMB, ICZ, VRC and CBF, but resistant to AZI and FCZ; The combination of AMB+ICZ, AMB+VRC, AMB+CBF and AMB+5FC  displayed a  synergistic activity. The combination of AMB and other antifungals  can be chosen for invasive aspergillosis.