年 年 年來 amphotericin B(ampho-B) flucytosine 來 療 切 療 不 1998 年 不 識 1 99% 療 88% ampho-b Fluconazole 2,3 說 類 I. Amphotericin B Ampho-B polyene antibiotics ergosterol (sterol) 裂 療 念 (candidiasis) (Aspergillosis) (Blastomycosis) (Cryptoccosis) (Histoplasmosis) (Mucormycosis) (Sporotrichosis) 療 不 度來 療 數 念 都 ampho-b 來 療 不 來 C krusei C glabrata ampho-b ampho-b 量 數 料 Ward ampho-b 度 度 Ampho-B 度 律不 不良 ampho-b 量 Faix 0.5 1mg/kg 量 ampho-b 量 0.1mg/kg 1mg/kg 量 (0.1mg/kg) 不 立 不 療 度 Baley 量 0.5~1mg/kg/day 5 療 量 0.5 1.5mg/kg 6-8 不 來說 念 1mg/kg 量 量 療 不 度 14
Donowitz 30 ampho-b 療 療 7 14 (0.5mg/kg 量 ) 療 量 (Minimal Inhibitory Concentrations MIC) 量 MIC 量列 Amphotericin B 度 量 FUNGUS MIC (ug/ml) TOTAL DOSE (mg/kg) Candida species 0.09-3.12 25-30 Cryptococcus 0.2-1.0 15-30 neoformans Coccidiodes immitis 0.78 70 Aspergillus species 1.9-4.0 15-45 Phycomycetes 3.0-6.0 Unknown 類 ampho-b : amphotericin B lipid complex (ABLC or Abelcet) amphotericin B colloidial dispersion (ABCD) liposomal amphotericin B (AmBisome) 9 療 AmBisome 療 ( ) 10, 11 量 1mg/kg/day 5mg/kg/dayg 臨 不 率 72.7% 92 粒 ampho-b (Liposomal amphotericin B) ampho-b 1 5mg/kg 量 療 都不 12 5-Fluorocytosine (5-FC) (fluoropyrimidine) 5-fluorouracil 療 念 ( 尿 ) ( ) 量 50 150mg/kg 六 ampho-b ampho-b 療 5-FC 來 療 念 療 Imidazole Miconazol imidazole 來 ergosterol 療 念 (Coccidioides) 量 例 來 療 療 Clotrimazole imidazole 療 Ketoconazole imidazole 念 念 (dermatophyte) ketoconazole 療 15
II. Nystatin Nystatin 漏 療 念 療 念 III. Griseofulvin 了 率 狀 裂 裂 來 力 Griseofulvin 力 量 10mg/kg 療 例 療 料 Ross (10mg/kg/day) 不良 見 Azoles 類 Fluconazole azole 類 14- -sterol demethylase( cytochrome P-450 sterol 力 療 念 Wiest ampho-b 5-fluorocytosine 療 Gurses Kalayci 療 年 fluconazole 療 不 率 68-73% 2, 13 Kaufman 度 (ELBW) fluconazole 度 (colonization) 3 Itraconazole, azole 類 不 零 例 不 不 Voriconazole fluconazole fluconazole 更 ampho-b 兩 cyclodextrin 不良 不 糖 (lactose) 糖 糖 (galactose) 不 不 零 voriconazole 14 療 療 azole 類 fluconazole 臨 fluconazol ampho-b C krusei C glabrata fluconazole Echinocandins 類 Capsofungin 理 echinocandin 類 echinocandin 類 -1-3 D gluca 行 率 量 15 Capsofungin 16
Bliss 論 量 參 ( 見 ) 16 療 17 療 更 量 16 量 Amphotericin B 0.5-1 mg/kg/day Q 24 hr IV Creatinine ABLC 5 mg/kg/day Q 24 hr IV Creatinine Liposomal Amphotericin 3-5 mg/kg/day Q 24 hr IV Creatinine B Fluconazole 6-12 mg/kg/day Week 1: Q 72 hr Week 2: Q 48 hr Week 3+: Q 24 hr IV, PO Creatinine Voriconazole Capsofungin 6 mg/kg IV load 4 mg/kg IV 50 mg/m2 Q 12 hr Q 24 hr IV, PO IV Calcium Creatinine 1. Rowen JL, Tate JM, for the neonatal candidiasis study group. Management of neonatal candidiasis. Pediatr Infect Dis J 1998;17:1007-1111 2. Huang YC, Lin TY, Lien RI, Chou YH, Kuo CY, Yang PH, Hsieh WS. Fluconazole therapy in neonatal candidemia. Am J of Perinatol 2000;17(8):411-5 3. Kaufman D, Boyle R, Hazen KC, Patrie JT, Robinson M, Donowitz LG. Fluconazole prophylaxis against fungal colonization and infection in preterm infants. N Engl J Med 2001;345:1660-6 4. Miller MJ. Infectious diseases of the fetus and newborn infant, 5 th ed. Philadelphia: W.B.Saunders;2001:835-9 17
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