Summary
Twenty-eight neutropenic (<500 granulocytes/µl) adults with microbiologically or histologically proven systemic mycosis were randomly assigned to receive either amphotericin B alone (0.5 mg/kg/day; n=14) or amphotericin B (0.5 mg/kg/day) plus 5-flucytosine (150 mg/kg/day; n=14) intravenously. Therapy was given for an average duration of 10 days in both groups, amounting to a total dose of amphotericin B of 338 mg and 308 mg, respectively. The mean duration of granulocytopenia was 18 days in the amphotericin B group and 20 days in the combination group. Only two patients treated with amphotericin B alone and three given the combination survived. Adverse events were similiar in both groups with an elevation of the serum creatinine in six cases during the administration of amphotericin B alone and in seven cases treated with the combination. No other serious adverse events were encountered. Treatment with both regimens was disappointing partly because mycosis was too far advanced by the time therapy was begun and neutrophils were recovered in only half the patients.
Zusammenfassung
Achtundzwanzig neutropenische (<500 Granulozyten/µl) Erwachsene mit einer mikrobiologisch oder klinisch nachgewiesenen, systemischen Mykose wurden randomisiert und behandelt mit Amphotericin B (0,5 mg/kg/Tag, n=14) oder mit einer Kombination von Amphotericin B (0,5 mg/kg/Tag) mit 5-Flucytosin (100 mg/kg/Tag, n=14) intravenös. Im Durchschnitt wurden beide Gruppen über 10 Tage behandelt, so daß sich eine totale Amphotericin B Dosis von 338 mg, bzw. 308 mg ergibt. Die Dauer der Granulozytopenie betrug durchschnittlich 18 Tage in der Amphotericin B Gruppe, und 20 Tage in der Gruppe mit Kombinationstherapie. Nur zwei Patienten in der Amphotericin B Gruppe und drei in der Kombinationsgruppe überlebten die Pilzinfektion. Die Nebenwirkungen waren vergleichbar in beiden Gruppen, mit einer Steigerung des Serum-Kreatinins bei sechs Patienten während der Verabreichung von Amphotericin B alleine, und bei sieben Patienten während der Kombinations-therapie. Andere ernsthafte Nebenwirkungen traten nicht auf. In beiden Gruppen war das Resultat der Behandlung enttäuschend, teilweise dadurch, daß die Mykose sich bereits am Anfang der Therapie zu weit entwickelt hatte und daß nur bei der Hälfte der Patienten ein Anstieg der neutrophilen Granulozyten stattfand.
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Verweij, P.E., Meis, J.F.G.M., Donnelly, J.P. et al. Amphotericin B versus amphotericin B plus 5-flucytosine: Poor results in the treatment of proven systemic mycoses in neutropenic patients. Infection 22, 81–85 (1994). https://doi.org/10.1007/BF01739009
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DOI: https://doi.org/10.1007/BF01739009