抗真菌药临床应用进展PPT.ppt

抗真菌药临床应用进展;真菌可感染人体各部位;深部真菌感染呈持续增多趋势;念珠菌血症: 罹患率及病死率1992-1999 NNIS;感染性疾病致死人数排序:美国;深部真菌感染的病原 –条件致病真菌;念珠菌血流感染的菌种分布 US (1998-2000);定义侵袭性真菌感染EORTC-IFICG NIAID-MSG;确诊Proven invasive fungal infections;拟诊Probable invasive fungal infetions;疑似Possible invasive fungal infections;GOAL OF ADAPTING DEFINITIONS;Treatment;治疗策略-1;治疗策略-2;治疗策略-1;治疗策略-4;Medical Mycology:The Last 50 Years;抗真菌药物;Amphotericin B;Amphotericin B;Amphotericin B;Amphotericin B;1. Ostrosky-Zeichner et al. Clin Infect Dis. 2003;37:415-425. 2. Bates et al. Clin Infect Dis. 2001;32:686-693.;Lipid Amphotericin B Formulations;Key Biopharmaceutical Differences of the Amphotericin B Formulations;Lipid AMB Formulations-Summary;Lipid AMB Formulations;Flucytosine;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 ;The Azoles;Fluconazole;Fluconazole ;Itraconazole;Itraconazole;Itraconazole;Itraconazole;Triazole Antifungals: Voriconazole, Posaconazole, Ravuconazole;VoriconazoleSummary of Pharmacokinetics;Adverse Events;伏立康唑适应症;泊沙康唑 (Posaconazole) ;2006.9 美国FDA批准上市，适应症 预防侵袭性曲霉病和念珠菌病感染 预防对象为13岁及以上高危的严重免疫缺陷患者，如造血干细胞移植受者发生GVHD或血液系统恶性肿瘤化疗后长期粒细胞缺乏 成人剂量200 mg (5 mL) tid 口咽部念珠菌病，包括伊曲康唑和/或氟康唑治疗无效者 首日100 mg (2.5 mL) bid，继以100 mg (2.5 mL) qd×13 日 用于伊曲康唑和/或氟康唑治疗无效者剂量为400 mg (10 mL) bid ;Kartsonis NA. Presented at the 12th European Congress of Clinical Microbiology and Infectious Diseases. April 24-27, 2002. Milan, Italy. ;Echinocandins: Caspofungin and Micafungin;Echinocandins: Caspofungin and Micafungin;卡泊芬净的适应症;米卡芬净 Micafungin ;阿尼芬净 Anidulafungin;Clinical Infectious Diseases 2006; 43:S28–39 ;Clinical Infectious Diseases 2006; 43:S28–39 ;Clinical Infectious Diseases 2006; 43:S28–39 ;Is the AMB-deoxycholate Era Over ?