慢性肝病时抗真菌药物的应用推荐.doc

慢性肝病患者常用抗真菌药物应用推荐 （文献来源：Periá?ez-Párraga L, Martínez-López I, Ventayol-Bosch P, Puigventós Latorre F, Delgado-Sánchez O. Drug dosage recommendations in patients with chronic liver disease. Rev Esp Enferm Dig 2012; 104: 165-184.） Drug 药物 (references) （参考文献） Huet and Kr?henbühl (11,12) category EH 肝提取率 Metabolism 代谢 Q0 肾外药物部分 PB (%) Recommendation 建议 Amphotericin B Lipid Complex* (9) 二性霉素B脂质体复合物 2 0.31 – 0.9 – In a HIV study in patients with cryptococcal meningitis was reduced to 50% in patients with significant hyperbilirubinemia (4 or 6 times the normal level) or elevation of transaminases (7 or 9 times the normal level) 在HIV研究中，隐球菌性脑膜炎的患者，具有显著高血胆红素血症（正常水平的4或6倍）或者是转氨酶升高（正常水平的7或9倍）的患者剂量减少到50%。 Amphotericin B Liposome* (9) 二性霉素B脂质体 3 0.012 – 0.9 No adjustment required 不需要调整 Anidulafungin* Prod Info Ecalta, 2007 (27) 阿尼芬净 3 0.003 Not undergo hepatic metabolism 不经过肝脏代谢 0.3 99 No adjustment required 不需要调整 Caspofungin* Prod Info Cancidas, 2009 (27) 卡泊芬净 3 0.004 N-acetylation and hydrolysis N-乙酰化和水解 0.59 97 Child-Pugh index = 7-9: 70 mg administered the first day, then 35 mg/24 recommends continuing Child-Pugh index ≥ 10: initial and maintenance dose 35 mg/24 h CPT 指数=7-9：第一天给予70mg，随后建议给予35mg/24h 维持量； CPT 指数≥ 10:初始剂量和维持剂量均为35mg/24h Fluconazole* (14) 氟康唑 3 0.002 Liver metabolism around 10% 肝脏代谢10% 0.2 11.0-12 Avoid in decompensated hepatitis 避免失代偿性肝炎 Griseofulvin (8) 灰黄霉素 4 Not known Extensive liver metabolism 广泛的肝代谢 0.8 Avoid Child-Pugh C index 避免C患者 Itraconazole* Prod Info Canadiol, 2010 (27) 伊曲康唑 2 0.4 Extensive liver metabolism (CYP 3A4) Enterohepatic circulation 广泛的肝代谢(CYP 3A4) 肠肝循环 0.55 99 Precaution Ketoconazole (14) 酮康唑 4 Not known Liver metabolism around 50%: oxidation 肝脏代谢50%：氧化作用 0.87 91-99 Monitor liver function. Avoid Child-Pugh C index 监测肝功能。避免C Micafungin* (14) 米卡芬净 2 0.36 Liver, extent unknown 肝脏程度未知 0.71 99 Monitor liver function. Avoid Child-Pugh C index 监测肝功能。C避免使用